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ORIGINAL ARTICLE   Free accessfree

Minerva Chirurgica 2019 June;74(3):203-6

DOI: 10.23736/S0026-4733.18.07719-2


lingua: Inglese

Early surgical management of acute cholecystitis in ultra-octogenarian patients: our 5-year experience

Alberto OLDANI 1 , Marcello CALABRÒ 1, Fabio MAROSO 1, Giacomo DEIRO 1, Lidia RAVIZZINI 1, Valentina GENTILE 1, Chiara MAGATON 1, Maurizio AMATO 2, Sergio GENTILLI 1

1 Division of General Surgery, Department of Health Sciences, University of Eastern Piedmont, Hospital “Maggiore della Carità”, Novara, Italy; 2 Department of Surgery and Advanced Technologies, University “Federico II”, Naples, Italy

BACKGROUND: Acute calculous cholecystitis is a leading cause for hospital admission especially in developed countries. As older age population increases, medical research should consider the efficacy of all therapeutic options, including early surgical procedure in an emergency context, for the treatment of acute cholecystitis in elderly high-risk patients.
METHODS: From 01/01/2012 to 31/12/2016, 245 patients were admitted to our Institution with diagnosis of acute cholecystitis and managed with cholecystectomy within the same hospitalization. The study population was divided into 2 subgroups: group A (patients aged more than 80 years) and group B (patients within the limit of 80 years of age); the objective of the study was to evaluate and compare the surgical outcomes of the 2 groups in terms of conversion rate, mortality rate, overall morbidity and procedure-related complication rates.
RESULTS: Statistical analysis did not show significant differences between ultra octogenarian and younger patients in terms of conversion to open procedure, iatrogenic bile duct lesions, postoperative peritoneal bleeding, bile leakage and peritoneal collection; no differences in terms of hospital stay have been demonstrated. Mortality and overall morbidity rates, even if similar to what observed in Literature and within acceptable values, were significantly higher in elderly patients, due to the presence of severe comorbidities leading to potentially fatal postoperative events.
CONCLUSIONS: Minimally invasive approach in an emergency setting for acute cholecystitis seems to be a feasible and adequate therapeutic approach for extremely aged high-risk patients.

KEY WORDS: Cholecystitis - Laparoscopy - Emergency medicine - Geriatrics

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