[Treatment of acute cholecystitis in the elderly: urgent surgery versus medical therapy and surgery delay].
BACKGROUND
Acute cholecystitis in elderly patients is a frequent disease characterized by a high mortality rate and serious complications. The choice between emergency surgery or conservative therapy in addition to delayed surgery is a controversial issue.


METHODS
Retrospective cohort study over patients aged 70 years or older undergoing acute cholecystitis treatment between 2003 and 2009. Epidemiological, clinical,diagnostic, surgical and cost-effectiveness parameters were analysed.


METHODS
We use Chi squared test, Student's t test and ANOVA. A level of p < 0.05 was accepted as significant.


RESULTS
During the six-year period studied 173 episodes of acute cholecystitis were treated on 147 patients (52% females), with an average age of 80.6 years (maximum 101). In 103 episodes (77 patients) medical treatment was taken, 31 of them undergone elective surgery by means of 100% laparoscopic approach, 6,4% conversion rate, 9,6% morbidity in absence of mortality. In other 85 patients emergency surgery was performed, 78.5% of them through laparoscopy approach with a conversion rate of 19.7%, 53% morbidity and 3,5% mortality.


CONCLUSIONS
Taking into account all variables, emergency surgery and medical treatment followed by elective cholecistectomy get similar outcomes, making better progress those who underwent early laparoscopic cholecystectomy.
Sánchez Beorlegui
Jesús
J
Servicio de Cirugía General y Digestiva, Fundación Hospital de Calahorra, Calahorra (La Rioja), España. js_beorlegui@hotmail.com
Lagunas Lostao
Emilio
E
Lamata Hernández
Félix
F
Monsalve Laguna
Eduardo César
EC
D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy; D041881:Cholecystitis, Acute / Q000601:surgery / Q000628:therapy*; D015331:Cohort Studies; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors