A retrospective comparison of older and younger adults undergoing early laparoscopic cholecystectomy for mild to moderate calculous cholecystitis. Systematic review of cholecystostomy as a treatment option in acute cholecystitis. Acute cholecystitis in high surgical risk patients: percutaneous cholecystostomy or emergency cholecystectomy? Conservative treatment versus endoscopic sphincterotomy in the initial management of acute cholecystitis in elderly patients at high surgical risk. Percutaneous Drainage versus Emergency Cholecystectomy for the Treatment of Acute Cholecystitis in Critically Ill Patients: Does it Matter? Prospective evaluation of patients with acute cholecystitis treated with percutaneous cholecystostomy and interval laparoscopic cholecystectomy. Preoperative Education in Cholecystectomy in the Context of a Multimodal Protocol of Perioperative Care: A Randomized, Controlled Trial Early minilaparoscopic cholecystectomy in patients with acute cholecystitis. Laparoscopic Versus Open Cholecystectomy: A Prospective Comparative Study in the Elderly With Acute Cholecystitis Conservative treatment for acute cholecystitis: clinical and radiographic predictors of failure. Acute cholecystitis in high risk surgical patients: percutaneous cholecystostomy versus laparoscopic cholecystectomy (CHOCOLATE trial): Study protocol for a randomized controlled trial Liberal Versus Restrictive Fluid Administration to Improve Recovery After Laparoscopic Cholecystectomy: A Randomized, Double-Blind Study Routine early laparoscopic cholecystectomy for acute cholecystitis after conclusion of a randomized controlled trial Prospective Evaluation of Emergency Versus Delayed Laparoscopic Cholecystectomy for Early Cholecystitis Frailty predicts outcome of elective laparoscopic cholecystectomy in geriatric patients Acute cholecystitis in high-risk patients: percutaneous cholecystostomy vs conservative treatment [Acute cholecystitis: timing of surgery].
OBJECTIVES To compare the demographic characteristics and intra- and postoperative outcomes in elderly adults ( ≥75 ) with those of younger adults undergoing early ( < 5 days after onset of complaints ) cholecystectomy .  DESIGN Retrospective analysis from May 2010 to August 2012 . SETTING R and omized , multicenter , clinical trial ( ABCAL Study , NCT01015417 ) . PARTICIPANTS Individuals with mild or moderate acute calculous cholecystitis ( ACC ) according to the Tokyo Guidelines ( N=414 ; n=78 aged 75 - 94 , median 82 ; n=336 aged 18 - 74 , median 49 ) . MEASUREMENTS Demographic characteristics and pre- , intra- , and postoperative data . RESULTS The elderly group was more likely to have an American Society of Anesthesiologists score of 3 or greater ( 62 % vs 23 % , P<.001 ) , higher serum creatinine ( 103 vs 74 μmol/L , P<.001 ) , and more-severe ACC ( moderate ACC ( 62 % vs 50 % , P=.05 ) , gangrenous cholecystitis ( 38 % vs 15 % , P=.001 ) ) on preoperative imaging and confirmed intraoperatively . Ulcerated mucosa ( 76 % vs 61 % , P=.001 ) was significantly more frequent in the elderly group . Operative time , postoperative mortality , and postoperative infectious ( 18 % vs 14 % , P=.35 ) and noninfectious ( 9 % vs 3 % , P=.80 ) complications were similar between the two groups . Median length of stay ( 7.0 vs 5.0 days , P=.54 ) and readmission rate ( 15 % vs 4 % , P=.07 ) were not significantly higher in the elderly group . No significant difference was observed for the subgroup of participants aged 80 and older . CONCLUSION In this r and omized trial that included a selected sample of older adults , there was no difference in major outcomes between elderly adults and their younger counterparts after early cholecystectomy . The findings are limited because important geriatric outcomes such as delirium and functional decline were not examined OBJECTIVES Percutaneous cholecystostomy ( PC ) is an established low-mortality treatment option for elderly and critically ill patients with acute cholecystitis . The primary aim of this review is to find out if there is any evidence in the literature to recommend PC rather than cholecystectomy for acute cholecystitis in the elderly population . METHODS In April 2007 , a systematic electronic data base search was performed on the subject of PC and cholecystectomy in the elderly population . After exclusions , 53 studies remained , comprising 1918 patients . Three papers described r and omized controlled trials ( RCTs ) , but none compared the outcomes of PC and cholecystectomy . A total of 19 papers on  mortality after cholecystectomy  in patients aged > 65 years were identified . RESULTS Successful intervention was seen in 85.6 % of patients with acute cholecystitis . A total of 40 % of patients treated with PC were later cholecystectomized , with a mortality rate of 1.96 % . Procedure mortality was 0.36 % , but 30-day mortality rates were 15.4 % in patients treated with PC and 4.5 % in those treated with acute cholecystectomy ( P < 0.001 ) . CONCLUSIONS There are no controlled studies evaluating the outcome of PC vs. cholecystectomy and the papers review ed are of evidence grade C. It is not possible to make definitive recommendations regarding treatment by PC or cholecystectomy in elderly or critically ill patients with acute cholecystitis . Low mortality rates after cholecystectomy in elderly patients with acute cholecystitis have been reported in recent years and therefore we believe it is time to launch an RCT to address this issue BACKGROUND Percutaneous cholecystostomy ( PC ) is an alternative treatment in  acute cholecystitis ( AC ) in high-risk or elderly patients although its advantage over emergency cholecystectomy has not yet been established . STUDY DESIGN AC prospect i ve data base analysis in high-risk patients treated by PC ( group 1 , 29 patients ) or emergency cholecystectomy ( group 2 , 32 patients ) . Surgical risk was estimated by physiological POSSUM , Charlson , Apache II , and American Society of Anesthesiologists ( ASA ) scores . RESULTS The groups showed homogeneity concerning age and surgical risk . PC allowed AC resolution in 19 patients ( 70.4 % ) , but 8 ( 29.6 % ) needed emergency cholecystectomy .  Morbidity and mortality rates were 31 % and 17.2 % , respectively . Mortality was significantly associated with ASA IV ( P = .01 ) . In group 2 , the morbidity rate was 28.1 % without mortality . There was no statistical difference in morbidity ( P = .6 ) although mortality was significantly higher in group 1 ( P = .02 ) . CONCLUSIONS PC seems of little benefit and ought to be left for those very old patients with surgical contraindication BACKGROUND AND STUDY AIMS Surgery in elderly patients with acute cholecystitis is quite a high-risk procedure . The recent finding that activated pancreatic enzyme is present in sterile bile from the acutely inflamed gallbladder suggests that obstruction at the level of the common channel is a possible precipitating factor . It was therefore hypothesized that an initial endoscopic sphincterotomy in patients with acute cholecystitis might improve the clinical course . PATIENTS AND METHODS A prospect i ve unselected series of 105 patients over 65 years of age ( 52 men , 53 women ; mean age 78 ) suffering from acute cholecystitis were initially treated on a r and om basis with either conservative methods or endoscopic sphincterotomy . Within the first 72 h after the onset of symptoms , all 52 patients in the endoscopic sphincterotomy group were managed by endoscopic retro grade cholangiopancreatography ( ERCP ) , combined with endoscopic sphincterotomy in 50 cases . The main study parameter was the need for emergency cholecystectomy  within the first week after admission . RESULTS Biliary sepsis requiring emergency surgery occurred in 15 patients in the conservatively treated group , in contrast with none of the 52 patients in the endoscopic sphincterotomy group ( P < 0.001 ) . Iatrogenic complications after endoscopic sphincterotomy  occurred in three patients , one of whom required surgery , while two were managed by conservative means . The clinical course improved , avoiding the need for emergency cholecystectomy and other interventions , in 48 patients in the endoscopic sphincterotomy group and in 36 patients in the conservatively treated group ( P < 0.01 ) . CONCLUSIONS The clinical course after endoscopic sphincterotomy  improved in the majority of elderly patients suffering from acute cholecystitis , suggesting that early relief of obstruction at the level of the common channel reduces the risk of developing biliary sepsis . The majority of these patients can undergo surgery electively or can receive further conservative treatment Background The aim if this study was to compare percutaneous drainage ( PD ) of the gallbladder to emergency cholecystectomy ( EC ) in a well-defined patient group with sepsis related to acute calculous/acalculous cholecystitis ( ACC/AAC ) . Methods Between 2001 and 2007 , all consecutive patients of our ICU treated by either PD or EC were retrospectively analyzed . Cases were collected from a prospect i ve data base . Percutaneous drainage was performed by a transhepatic route and EC by open or laparoscopic approach . Patients ’ general condition and organ dysfunction were assessed by two vali date d scoring systems ( SAPS II and SOFA , respectively ) . Morbidity , mortality , and long-term outcome were systematic ally review ed and analyzed in both groups . Results Forty-two patients [ median age = 65.5 years ( range = 32–94 ) ] were included ; 45 % underwent EC  ( ten laparoscopic , nine open ) and 55 % PD ( n = 23 ) . Both patient groups had similar preoperative characteristics .  Percutaneous drainage and EC  were successful in 91 and 100 % of patients , respectively . Organ dysfunctions were similarly improved by the third postoperative/postdrainage days . Despite undergoing PD , two patients required EC due to gangrenous cholecystitis . The conversion rate after laparoscopy was 20 % . Overall morbidity was 8.7 % after PD and 47 % after EC ( P = 0.011 ) . Major morbidity was 0 % after PD and 21 % after EC ( P = 0.034 ) . The mortality rate was not different ( 13 % after PD and 16 % after EC , P = 1.0 ) and the deaths were all related to the patients ’ preexisting disease . Hospital and ICU stays were not different . Recurrent symptoms ( 17 % ) occurred only after ACC in the PD group . Conclusions In high-risk patients , PD and EC are both efficient in the resolution of acute cholecystitis sepsis . However , EC is associated with a higher procedure-related morbidity and the laparoscopic approach is not always possible . Percutaneous drainage represents a valuable intervention , but secondary cholecystectomy is m and atory in cases of acute calculous cholecystitis BACKGROUND Emergency laparoscopic cholecystectomy has been advocated for the treatment of acute cholecystitis ; however it can be a difficult task , especially in public hospitals , with relatively high conversion and complication rates . Percutaneous cholecystostomy is a simple and effective procedure allowing patients to recover from the acute event and undergo elective laparoscopic surgery at a later stage . METHODS We prospect ively assessed a protocol of initial conservative treatment in patients admitted with acute cholecystitis . Patients who did not respond to medical treatment were treated by percutaneous cholecystostomy .  Following discharge the patients were seen in the outpatient clinic and elective laparoscopic cholecystectomy was considered and scheduled as necessary . The details of the operation were collected with emphasis on complications and conversion rate . RESULTS During a 3-year period , 224 patients who were admitted with acute calculous cholecystitis entered the protocol . Fifty-four patients did not improve under medical treatment and percutaneous cholecystostomy was performed . In spite of adequate drainage , 5 patients still did not improve : 3 patients were successfully operated upon urgently and recovered , while 2 patients who had severe concomitant diseases and multi-organ failure , died . Forty-nine patients were discharged with the catheter and later re-evaluated for elective operation . In 7 patients common bile duct stones were found and were removed by ERCP prior to the elective operation . Twenty-five patients underwent delayed laparoscopic cholecystectomy with a low conversion rate ( 8 % ) , and only minor complications ( 16 % ) . CONCLUSIONS Conservative treatment and delayed operation is still an acceptable choice in the treatment of acute cholecystitis . Percutaneous cholecystostomy is an effective tool , with high success rate and low morbidity , and allows for better pre-operative evaluation of the biliary system and safe interval laparoscopic surgery . Laparoscopic cholecystectomy after drainage of the gall bladder is a low morbidity procedure with relatively low conversion rate Abstract Background Preoperative education is a key point in multimodal protocol s of perioperative care . We investigated whether preoperative education for patients undergoing open cholecystectomy would reduce the incidence of perioperative symptoms . Methods This was a r and omized , single-blinded , clinical trial that included adult ( 18–65 years old ) c and i date s for elective open cholecystectomy . All patients took part in the ERAS/ACERTO protocol of perioperative care except that only the intervention group received preoperative education .  The main endpoints of the study were the presence and intensity of postoperative symptoms ( e.g. , nausea , vomiting , pain ) measured by a visual analogue scale , 24 h after the operation . Results A total of 74 patients ( 34 in the intervention group , 40 in the control group ) completed the study . The intervention group had significantly lower median ( interquartile range ) scores for nausea [ 0 ( 4 ) vs. 2.5 ( 5.8 ) , p = 0.04 ] and pain [ 0.2 ( 2.3 ) vs. 3.1 ( 3.45 ) , p < 0.01 ] than the controls . High well-being ( score ≥6 ) was reported by 79.4 % ( 27 patients ) of the intervention group in contrast to 57.5 % ( 23 patients ) of the controls ( p = 0.04 ) . Conclusions Preoperative education is highly effective in the context of a multimodal protocol for enhancing the recovery of patients su bmi tted to open cholecystectomy BACKGROUND Recently , techniques using fine-caliber instruments ( 2 or 3 mm in diameter ) for laparoscopic cholecystectomy , called minilaparoscopic cholecystectomy ( MLC ) , were reported to be superior to conventional LC ( CLC , using 5 mm instruments ) in postoperative course and cosmetic outcome . However , the use of MLC to date has been largely restricted to uncomplicated situations . Since CLC has been proved to be a safe and efficient technique for acute cholecystitis especially if conducted early , this study tests the feasibility and safety of MLC for acute cholecystitis . METHODS Sixty-nine consecutive patients with acute cholecystitis were prospect ively r and omized to  minilaparoscopic  ( n = 38 ) or conventional laparoscopic  ( n = 31 )  cholecystectomy  , and the operations were conducted within 2 days of admission whenever possible . Despite different operative techniques , both groups of patients received identical preoperative preparation , evaluation and postoperative care . The two groups were compared for patient characteristics , results of laboratory tests , predictive score for LC difficulties , operative time , operative complications , hospitalization days and need for meperidine injection for wound pain . RESULTS The conversion rate was 7.9 % ( 3 of 38 ) for the MLC group and 6.5 % ( 2 of 31 ) for the CLC group . Nine patients in the  MLC group and 7 in the CLC group had concomitant choledocholithiasis and underwent endoscopic stone retrieval  before operation . The age , sex , predictive score for LC difficulties , preoperative leukocyte count , length of hospital stay and requirement of intramuscular meperidine injections were similar for both groups of patients , while , the operative times were marginally longer in the MLC group ( 113.8 + /- 30.8 versus 98.2 + /- 33.2 minutes , P = 0.056 ) . No major complications occurred in either group . CONCLUSIONS The results of cholecystectomy for acute cholecystitis by MLC are as good as those of CLC if the operation is performed early , with obvious smaller incisions and minimal complications . MLC is a safe and effective procedure for patients with acute cholecystitis , and has an acceptable low conversion rate The aim of this prospect i ve comparative study was to determine the feasibility and the efficacy of laparoscopic cholecystectomy for acute cholecystitis in patients older than 75 years of age and to compare the results with those of open cholecystectomy . From January 1992 to December 1999 , 139 patients older than 75 years of age underwent cholecystectomy for acute cholecystitis . The two groups of patients with cholecystolithiasis included 50 patients who underwent laparoscopic cholecystectomy ( group 1 ) and 89 patients who underwent open cholecystectomy ( group 2 ) . Group 1 consisted of 30 women and 20 men , with a mean age of 81.9 years ( range , 75–98 ) . Group 2 consisted of 51 women and 38 men , with a mean age of 81.9 years ( range , 75–93 ) . There was no difference in the American Society of Anesthesiologists classification in both groups . The length of the surgery ( 103.3 vs. 149.7 minutes ) , postoperative length of stay ( 7.7 vs. 12.7 days ) , and inpatient rehabilitation ( 15 vs. 42 patients ) were significantly shorter in group 1 than in group 2 . The postoperative morbidity rate was not different between the groups . There was no mortality in group 1 , but four patients died in group 2 ( P = 0.29 ) . The conversion rate was 32 % ( n = 16 ) in group 1 . In summary , laparoscopic cholecystectomy  in elderly patients with acute cholecystitis  is safe and effective .  Laparoscopic cholecystectomy in elderly patients restores them to the best possible quality of life with the lowest cost to them physiologically BACKGROUND Current treatment options for acute calculous cholecystitis include either early cholecystectomy , or conservative treatment consisting of intravenous antibiotics and an interval cholecystectomy several weeks later . Percutaneous drainage is reserved for patients in whom conservative therapy failed or as a salvage procedure for high risk patients . OBJECTIVE To identify clinical and radiographic factors leading to failure of conservative treatment . METHODS We prospect ively collected data on consecutive patients admitted with the diagnosis of acute cholecystitis . Parameters were compared between patients who were successfully treated conservatively and those who required percutaneous cholecystostomy . Logistic regression analysis was performed to identify predictors for failure of conservative treatment . RESULTS The study population comprised 103 patients with a median age of 60 who were treated for acute cholecystitis . Twenty-seven patients ( 26.2 % ) required PC . On univariate analysis , age above 70 years , diabetes , elevated white blood cell count , tachycardia ( > 100 beats/min ) at admission , and a distended gallbladder ( > 5 cm transverse diameter ) were found to be significantly more common in the PC group ( P < 0.001 ) . WBC was higher in the PC group throughout the initial 48 hours . On multivariate analysis , age above 70 ( odds ratio 3.6 ) , diabetes ( OR 9.4 ) , tachycardia at admission ( OR 5.6 ) , and a distended gallbladder ( OR 8.5 ) were predictors for cholecystostomy ( P < 0.001 ) . Age above 70 ( OR 5.2 ) and WBC $ 15,000 ( OR 13.7 ) were predictors for failure of conservative treatment after 24 and 48 hours ( P < 0.001 ) . CONCLUSIONS Age above 70 , diabetes , and a distended gallbladder are predictors for failure of conservative treatment and such patients should be considered for early cholecystostomy . Persistently elevated WBC ( > 15,000 ) suggests refractory disease and should play a central role in the clinical follow-up and decision-making process for elderly patients with acute cholecystitis Background Laparoscopic cholecystectomy in acute calculous cholecystitis in high risk patients can lead to significant morbidity and mortality .  Percutaneous cholecystostomy may be an alternative treatment option but the current literature does not provide the surgical community with evidence based advice . Methods / Design The CHOCOLATE trial is a r and omised controlled , parallel-group , superiority multicenter trial . High risk patients , defined as APACHE-II score 7 - 14 , with acute calculous cholecystitis will be r and omised to  laparoscopic cholecystectomy or percutaneous cholecystostomy . During a two year period 284 patients will be enrolled from 30 high volume teaching hospitals . The primary endpoint is a composite endpoint of major complications within three months following r and omization and need for re-intervention and mortality during the follow-up period of one year . Secondary endpoints include all other complications , duration of hospital admission , difficulty of procedures and total costs . Discussion The CHOCOLATE trial is design ed to provide the surgical community with an evidence based guideline in the treatment of acute calculous cholecystitis in high risk patients .Trial Registration Netherl and s Trial Register ( NTR ) : Objective : The objective of this study was to investigate the effects of 2 levels of intraoperative fluid administration on perioperative physiology and outcome after laparoscopic cholecystectomy . Summary Background Data : Intraoperative fluid administration is variable as a result of limited knowledge of physiological and clinical effects of different fluid substitution regimens . Methods : In a double-blind study , 48 ASA I – II patients undergoing laparoscopic cholecystectomy were r and omized to 15 mL/kg ( group 1 ) or 40 mL/kg ( group 2 ) intraoperative administration of lactated Ringer ’s solution ( LR ) . All other aspects of perioperative management as well as preoperative fluid status were st and ardized . Primary outcome parameters were assessed repeatedly for the first 24 postoperative hours and included pulmonary function ( spirometry ) , exercise capacity ( submaximal treadmill test ) , cardiovascular hormonal responses , balance function , pain , nausea and vomiting , recovery , and hospital stay . Results : Intraoperative administration of 40 mL/kg compared with 15 mL/kg LR led to significant improvements in postoperative pulmonary function and exercise capacity and a reduced stress response ( aldosterone , antidiuretic hormone , and angiotensin II ) . Nausea , general well-being , thirst , dizziness , drowsiness , fatigue , and balance function were also significantly improved , as well as significantly more patients fulfilled discharge criteria and were discharged on the day of surgery with the high-volume fluid substitution . Conclusions : Intraoperative administration of 40 mL/kg compared with 15 mL/kg LR improves postoperative organ functions and recovery and shortens hospital stay after laparoscopic cholecystectomy The aim of this retrospective review was to assess the clinical outcomes of  laparoscopic cholecystectomy  for acute cholecystitis since the conclusion of a r and omized controlled trial in 1997 Treatment of acute cholecystitis is still under debate . The aim of this study was to evaluate the efficacy of early laparoscopic cholecystectomy ( ELC ) in comparison with conservative treatment followed by delayed laparoscopic cholecystectomy ( DLC ) in the management of acute cholecystitis . This prospect i ve comparative study involved two groups of patients presenting with acute cholecystitis within 72 hours of the onset of symptoms . ELC was performed in 82 consecutive patients , whereas DLC was performed in 87 patients who previously underwent medical treatment .  Surgical variables , hospital stay , and postoperative morbidity were evaluated in both groups . Time of surgery and conversion rate were lower in the ELC group . Postoperative morbidity was similar in both groups . Overall hospital stay was shorter in the ELC group . ELC within 72 hours of the onset of acute cholecystitis is a safe procedure with better results than DLC in terms of surgical timing , conversion rate , and hospital stay Background Frailty is a phenotype characterized by complex and challenging medical problems and higher susceptibility to adverse health outcomes . It can be derived at by a multidimensional process known as comprehensive geriatric assessment ( CGA ) , which assesses the functional reserves of the elderly . In this study we report for the first time on a prospect i ve evaluation of the association between CGA and postoperative complications after elective laparoscopic cholecystectomy for biliary disease . Methods Fifty-seven patients older than 65 years who were to undergo elective laparoscopic cholecystectomy for uncomplicated biliary disease were prospect ively examined .  Preoperative CGA was performed and the patients were categorized as fit or frail . The main outcome of the study was the rate of any postoperative complication within 30 days of surgery . Results There were 29 women ( 50.9 % ) and the median ( interquartile range ) age of the cohort was 73 ( 8.8 ) years . Thirty-two patients ( 56.1 % ) were categorized as frail and 25 ( 43.9 % ) as fit . The overall incidence of postoperative complications was 23.7 % , most of which were grade I and II ( 18.8 % ) . Frail patients , according to the CGA assessment , experienced a significantly higher incidence of postoperative complications compared to their fit counterparts ( 84.6 vs. 15.4 % , p = 0.023 ) . Frail patients experienced a significantly higher frequency of prolonged ( more than 2 days ) postoperative hospital stay compared with their fit counterparts ( p = 0.023 ) . Conclusions Preoperative CGA may predict postoperative complications and prolonged postoperative hospital stay of elderly patients who undergo elective laparoscopic cholecystectomy . Larger-scale studies independently assessing this association are warranted Abstract . Our objective was to compare the effectiveness of percutaneous cholecystostomy ( PC ) vs conservative treatment ( CO ) in high-risk patients with acute cholecystitis . The study was r and omized and comprised 123 high-risk patients with acute cholecystitis . All patients fulfilled the ultrasonographic criteria of acute inflammation and had an APACHE II score ≥12 .  Percutaneous cholecystostomy guided by US or CT was successful in 60 of 63 patients ( 95.2 % ) who comprised the PC group . Sixty patients were conservatively treated ( CO group ) . One patient died after unsuccessful PC ( 1.6 % ) . Resolution of symptoms occurred in 54 of 63 patients ( 86 % ) . Eleven patients ( 17.5 % ) died either of ongoing sepsis ( n=6 ) or severe underlying disease ( n=5 ) within 30 days . Seven patients ( 11 % ) were operated on because of persisting symptoms ( n=3 ) , catheter dislodgment ( n=3 ) , or unsuccessful PC ( n=1 ) . Cholecystolithotripsy was performed in 5 patients ( 8 % ) . Elective surgery was performed in 9 cases ( 14 % ) . No further treatment was needed in 32 patients ( 51 % ) . In the CO group , 52 patients ( 87 % ) fully recovered and 8 patients ( 13 % ) died of ongoing sepsis within 30 days . All successfully treated patients showed clinical improvement during the first 3 days of treatment . Percutaneous cholecystostomy in high-risk patients with acute cholecystitis did not decrease mortality in relation to conservative treatment . Percutaneous cholecystostomy might be suggested to patients not presenting clinical improvement following 3 days of conservative treatment , to critically ill intensive care unit patients , or to c and i date s for percutaneous cholecystolithotripsy The authors report their own experience about 156 cases of acute cholecystitis observed between January 1991 and October 1992 . The most part of the patients were between 30 and 65 years old ( 84 cases observed ) . In 27 cases , for the positive evolution of the pathology , it was put on practice a non operative treatment . The other 129 cases were treated surgically . The patients with lithiasic cholecystitis were 148 ; those affected by non lithiasic cholecystitis were 5 ; and 3 of them presented an acute cholecystitis as a manifestation of a carcinoma . Between the various diagnostic methods , the echography , executed in emergency , is considered as an indispensable one , for having changed completely the diagnostic approach . It is discussed , particularly , the timing of surgery , an aspect able to influence considerably the therapeutic iter and its results . There are analysed the criteria for whom some authors are favourable to a medical treatment of the acute cholecystitis , postponing the operation , while other of them are favourable to an early surgical treatment . The authors ' casuistry put in evidence 110 operations effectuated in emergency ( < 12 hours ) , 19 operations after an 12 - 72 hours interval , no operations at a long distance ( 1 - 10 months ) . The results are to be considered satisfactory : 1 deceased ( on 129 operated cases , 0.78 % ) ; 10 immediate complications ( 7.75 % ) : 8 suppurations of the wound , 1 biliar fistula and 1 internal hemorrhage after video-laparoscopic operation ; 2 late complications ( 1.55 % ) : they were relapsing gallstones . The aim of this work is to offer a contribution to codification of the treatment of the acute cholecystitis , on the ground of the acquired experience
Conclusion : Early cholecystectomy seems to be a feasible treatment in elderly patients with acute cholecystitis .
Background : In the era of advanced surgical techniques and improved perioperative care , the willingness to perform emergency operations in elderly patients continues to increase .
This systematic review aim ed at assessing the clinical outcomes of early cholecystectomy in elderly patients with acute cholecystitis .