Skip to main content
SpringerLink
Log in

Primary cholecystectomy is feasible in elderly patients with acute cholecystitis

  • Original Article
  • Published:
Aging Clinical and Experimental Research Aims and scope Submit manuscript

Abstract

Background

While early cholecystectomy is generally accepted as the standard procedure for young and fit patients with acute cholecystitis, controversy exits on the management of elderly and severely sick patients. We postulated that primary cholecystectomy is feasible in this subgroup. The aim of this study was to compare the outcomes of young and fit patients to those of elderly patients undergoing surgery for acute cholecystitis.

Methods

The outcomes of elderly patients (≥70 years) undergoing surgery for acute cholecystitis in a primary care center in Germany were retrospectively compared to those of younger patients (<70 years).

Results

152 patients, 74 aged ≥ 70 years (study group) and 78 < 70 years (control) were included for analysis. The study group was significantly older at the time of surgery (78 vs. 68 years, p = 0.02). Severe cholecystitis was seen in a significant number of cases in the study group, p = 0.01. Equally, the mean WBC (19.5 vs. 17, p = 0.02), CRP (26 vs. 22, p = 0.04) and APACHE II score (17 vs. 8, p = 0.01) were significantly higher in the study group. There was no significant difference in the duration of anesthesia (123 vs. 133 min, p = 0.70) and surgery (72 vs. 81 min, p = 0.90) amongst both groups. There was no significant difference in rate of complication amongst both groups (24 vs. 14 %, p = 0.11). Two cases of mortality were recorded (1.3 %) in the study group.

Conclusion

The age of the patient cannot be the sole factor in deciding whether or not a patient with acute cholecystitis is fit for surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Ambe P, Esfahani BJ, Tasci I et al (2011) Is laparoscopic cholecystectomy more challenging in male patients? Surg Endosc Interv Tech 25(7):2236–2240

    Article  Google Scholar 

  2. Ambe P, Weber SA, Christ H et al (2014) Cholecystectomy for acute cholecystitis. How time-critical are the so called “golden 72 hours”? Or better “golden 24 hours” and “silver 25-72 hour”? A case control study. World J Emerg Surg 9(1):60

    Article  PubMed Central  PubMed  Google Scholar 

  3. Banz V, Gsponer T, Candinas D et al (2011) Population-based analysis of 4113 patients with acute cholecystitis: defining the optimal time-point for laparoscopic cholecystectomy. Ann Surg 254(6):964–970

    Article  PubMed  Google Scholar 

  4. Gurusamy K, Samraj K, Gluud C et al (2010) Meta-analysis of randomized controlled trials on the safety and effectiveness of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 97(2):141–150

    Article  CAS  PubMed  Google Scholar 

  5. Gurusamy KS, Davidson C, Gluud C et al (2013) Early versus delayed laparoscopic cholecystectomy for people with acute cholecystitis. Cochrane Database Syst Rev 6:CD005440

    PubMed  Google Scholar 

  6. Gutt CN, Encke J, Köninger J et al (2013) Acute cholecystitis: early versus delayed cholecystectomy, a multicenter randomized trial (ACDC Study, NCT00447304). Ann Surg 258(3):385–391

    Article  PubMed  Google Scholar 

  7. Kolla SB, Aggarwal S, Kumar A et al (2004) Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a prospective randomized trial. Surg Endosc 18(9):1323–1327

    Article  CAS  PubMed  Google Scholar 

  8. Papi C, Catarci M, D’Ambrosio L et al (2004) Timing of cholecystectomy for acute calculous cholecystitis: a meta-analysis. Am J Gastroenterol 99(1):147–155

    Article  PubMed  Google Scholar 

  9. Bergman S, Sourial N, Vedel I et al (2011) Gallstone disease in the elderly: are older patients managed differently? Surg Endosc 25(1):55–61

    Article  PubMed  Google Scholar 

  10. McGillicuddy EA, Schuster KM, Barre K et al (2012) Non-operative management of acute cholecystitis in the elderly. Br J Surg 99(9):1254–1261

    Article  CAS  PubMed  Google Scholar 

  11. Nazeer MA, Ali M, Ahmed K et al (2012) Outcomes of laparoscopic cholecystectomy in the elderly versus young patients. Pak J Med Health Sci 6(3):544–546

    Google Scholar 

  12. Nielsen LBJ, Harboe KM, Bardram L (2013) Cholecystectomy for the elderly: no hesitation for otherwise healthy patients. Surg Endosc 1–7

  13. Vracko J, Markovic S, Wiechel KL (2006) Conservative treatment versus endoscopic sphincterotomy in the initial management of acute cholecystitis in elderly patients at high surgical risk. Endoscopy 38(8):773–778

    Article  CAS  PubMed  Google Scholar 

  14. Al-Jundi W, Cannon T, Antakia R et al (2012) Percutaneous cholecystostomy as an alternative to cholecystectomy in high risk patients with biliary sepsis: a district general hospital experience. Ann R Coll Surg Engl 94(2):99–101

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  15. Cherng N, Witkowski ET, Sneider EB et al (2012) Use of cholecystostomy tubes in the management of patients with primary diagnosis of acute cholecystitis. J Am Coll Surg 214(2):196–201

    Article  PubMed  Google Scholar 

  16. Cull JD, Velasco JM, Czubak A et al (2013) Management of Acute Cholecystitis: Prevalence of Percutaneous Cholecystostomy and Delayed Cholecystectomy in the Elderly. J Gastrointest Surg 1–6

  17. Kapan M, Onder A, Tekbas G et al (2013) Percutaneous cholecystostomy in high-risk elderly patients with acute cholecystitis: a lifesaving option. Am J Hosp Palliat Med 30(2):167–171

    Article  Google Scholar 

  18. Yamashita Y, Takada T, Kawarada Y et al (2007) Surgical treatment of patients with acute cholecystitis: Tokyo guidelines. J Hepatobiliary Pancreat Surg 14(1):91–97

    Article  PubMed Central  PubMed  Google Scholar 

  19. Yokoe M, Takada T, Strasberg SM et al (2012) New diagnostic criteria and severity assessment of acute cholecystitis in revised Tokyo guidelines. J Hepato Biliary Pancreat Sci 19(5):578–585

    Article  Google Scholar 

  20. Kortram K, van Ramshorst B, Bollen TL et al (2012) Acute cholecystitis in high risk surgical patients: percutaneous cholecystostomy versus laparoscopic cholecystectomy (CHOCOLATE trial): study protocol for a randomized controlled trial. Trials 13

  21. Simorov A, Ranade A, Parcells J et al (2013) Emergent cholecystostomy is superior to open cholecystectomy in extremely ill patients with acalculous cholecystitis: a large multicenter outcome study. Am J Surg 206(6):935–941

    Article  PubMed  Google Scholar 

  22. Smith TJ, Manske JG, Mathiason MA et al (2013) Changing trends and outcomes in the use of percutaneous cholecystostomy tubes for acute cholecystitis. Ann Surg 257(6):1112–1115

    Article  PubMed  Google Scholar 

  23. Zerem E, Omerović S, Imširović B (2013) Is surgical cholecystectomy better than percutaneous in treatment of acute cholecystitis in patients unfit for surgery? J Gastrointest Surg 17(8):1542–1543

    Article  PubMed  Google Scholar 

  24. Abraham S, Rivero HG, Erlikh IV et al (2014) Surgical and nonsurgical management of gallstones. Am Fam Physician 89(10):795–802

    PubMed  Google Scholar 

  25. Anderson JE, Inui T, Talamini MA et al (2014) Cholecystostomy offers no survival benefit in patients with acute acalculous cholecystitis and severe sepsis and shock. J Surg Res 190(2):517–521

    Article  PubMed  Google Scholar 

  26. Laurila J, Syrjala H, Laurila PA et al (2004) Acute acalculous cholecystitis in critically ill patients. Acta Anaesthesiol Scand 48(8):986–991

    Article  CAS  PubMed  Google Scholar 

  27. Morse BC, Smith JB, Lawdahl RB et al (2010) Management of acute cholecystitis in critically ill patients: contemporary role for cholecystostomy and subsequent cholecystectomy. Am Surg 76(7):708–712

    PubMed  Google Scholar 

  28. Gurusamy KS, Rossi M, Davidson BR (2013) Percutaneous cholecystostomy for high-risk surgical patients with acute calculous cholecystitis. Cochrane Database Syst Rev 8:CD007088

    PubMed  Google Scholar 

  29. Knaus WA, Draper EA, Wagner DP et al (1985) APACHE II: a severity of disease classification system. Crit Care Med 13(10):818–829

    Article  CAS  PubMed  Google Scholar 

  30. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  PubMed Central  PubMed  Google Scholar 

  31. Buanes T, Mjaland O (1996) Complications in laparoscopic and open cholecystectomy: a prospective comparative trial. Surg Laparosc Endosc 6(4):266–272

    Article  CAS  PubMed  Google Scholar 

  32. Lujan JA, Parrilla P, Robles R et al (1998) Laparoscopic cholecystectomy vs open cholecystectomy in the treatment of acute cholecystitis: a prospective study. Arch Surg 133(2):173–175

    Article  CAS  PubMed  Google Scholar 

  33. Bingener J, Richards ML, Schwesinger WH et al (2003) Laparoscopic cholecystectomy for elderly patients: gold standard for golden years? Arch Surg 138(5):531–535 (discussion 535–536)

    Article  PubMed  Google Scholar 

  34. Brunt LM, Quasebarth MA, Dunnegan DL et al (2001) Outcomes analysis of laparoscopic cholecystectomy in the extremely elderly. Surg Endosc 15(7):700–705

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Human and Animal Rights

This study was performed in accordance with the Helsinki Declaration on human rights and was approved by the departmental board of review at the St. Remigius Hospital.

Informed consent

An informed consent was obtained from all subjects.

Author information

Authors and Affiliations

  1. Department of Surgery II, Helios Klinikum Wuppertal, Witten/Herdecke University, Heusner Str. 40, 42283, Wuppertal, Germany

    Peter C. Ambe

  2. Department of Internal Medicine, St. Elisabeth Hospital Hohenlind, Werthmannstr. 1, 50935, Cologne, Germany

    Sebastian A. Weber

  3. Department of Medical Statistics and Epidemiology, University of Colonge, Kerpener Str. 62, 50937, Cologne, Germany

    Hildegard Christ

  4. Department of General, Visceral and Thoracic Surgery, St. Remigius Hospital Opladen, An St. Remigius 26, 51379, Leverkusen, Germany

    Peter C. Ambe & Dirk Wassenberg

Authors
  1. Peter C. Ambe
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sebastian A. Weber
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hildegard Christ
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dirk Wassenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Peter C. Ambe.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ambe, P.C., Weber, S.A., Christ, H. et al. Primary cholecystectomy is feasible in elderly patients with acute cholecystitis. Aging Clin Exp Res 27, 921–926 (2015). https://doi.org/10.1007/s40520-015-0361-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40520-015-0361-0

Keywords

Search

Navigation