Conservative Management of Gallstone Disease in the Elderly Population: Outcomes and Recurrence

Abstract

Background & Aims: The prevalence of gallstone disease increases with age, being early cholecystectomy the most accepted treatment in the vast majority of patients in order to prevent complications and recurrence. The aim of this study is to determine the recurrence rate and its possible predictors after initial non-operative management. Materials and Methods: We reviewed a consecutive series of patients, older than 65 years, admitted for a gallstone-related disease and treated with a non-operative management between January 2010 and December 2013. We analyzed comorbidities, clinical data, diagnosis, management, recurrence, and its treatment. Median follow-up after the discharge was 2 years. Recurrence was analyzed by a Kaplan–Meier survival curve. Possible recurrence’s predictors were analyzed. Results: The study included 226 patients. Mean age was 80.4 ± 7.2 years, 127 (56%) were female. The main causes of index hospitalization were acute cholecystitis (58%) and biliary pancreatitis (18.1%). After 2 years of follow-up, the recurrence rate was 39.8%; mean time to recurrence was 255.2 ± 42.1 days, 81% of patients recurred within 1 year. Bile duct disease implied a higher recurrence rate than the gallbladder disease group (52% vs 33%, p < 0.001). Subjects with two or more diagnoses during index admission presented higher recurrence rate (32% vs 49%, p < 0.001). Conclusion: More than a third of elderly patients could present a recurrence within 2 years after initial non-operative management. Early cholecystectomy should be considered at index admission in order to prevent recurrence.

Does the Surgeon’s Caseload Affect the Outcome in Laparoscopic Cholecystectomy for Acute Cholecystitis?

“…Laparoscopic cholecystectomy (LCC) is a common procedure performed by gastrointestinal (GI) surgeons, and several reports recommend early cholecystectomy for acute cholecystitis (1)(2)(3)(4). LCC for acute cholecystitis is associated with a higher risk of conversion compared with elective LCC, since the inflamed tissues and the distorted anatomy might prove an obstacle too hard to overcome laparoscopically.…”

Perioperative outcomes after laparoscopic cholecystectomy in elderly patients: a systematic review and meta-analysis

“…cholecystectomy. Many studies evaluating outcomes of laparoscopic cholecystectomy in their definition of elderly patients versus younger patients have shown that increasing age leads to higher conversion rates, more complications and a longer hospital stay [7][8][9][10].…”

“…With an ageing population, demands for surgery are expected to rise over the next decade with associated increasing frailty [ 5 , 6 ]. In parallel, it is estimated that increasing numbers of elderly patients will present with gallstone disease [ 7 , 8 ], and it is thought that patients aged 80–89 years account for 28% and 42% of male and female patients, respectively [ 8 , 9 ]. Since age is associated with existence of multiple comorbidities and reduced functional reserve, it is thought that operating on elderly patients could be associated with an increased risk of complications [ 10 – 12 ].…”

Symptomatic Gallstones in Young Patients Under the Age of 30 Years

“…The elderly were commonly seen with gallstone disease; this was attributed to the aging and sedentary lifestyle of the elderly population. Similarly, Mora-Guzmán et al revealed that elderly patients were at a higher risk of developing gallstones and gallstone-related complications along with recurrence of gallstones in one-third of patient follow-ups [ 17 ].…”