Cholecystectomy in Elderly: Challenge and Critical Analysis of Available Evidence

The incidence of gallstone disease in the elderly population ranges from 14 to 27%.The prevalence of gallstones increases with age. It ranges from 20 to 30% in patients aged ≥60 years [1, 2], and according to several potentially high severity studies, especially with patients presenting with complications, the prevalence increases to 80% in institutionalized individuals aged ≥90 years [3]. One such complication is acute cholecystitis, which is a frequent reason for an emergency presentation to hospital. Surgery for cholelithiasis is more common in elderly patients since the incidence of gallstones increases with age (13–50%). It is the higher frequency of associated pathologies in patients older than 60 years of age that can influence the type and effectiveness of treatment. In elderly patients, the optimal treatment of acute cholecystitis remains controversial. LC is the gold standard for the treatment of gallbladder stone disease. Even though laparoscopic cholecystectomy has become the gold standard for the treatment of gallbladder stones, its safety in elderly patients is still questioned [4–6]. In comparison with the open approach, the advantages of this procedure include better cosmetic results, less postoperative pain, shorter operative time, less intraoperative and postoperative complications and shorter postoperative hospital stay both in younger and older people. This chapter considers the question of whether to recommend laparoscopic or open cholecystectomy in elderly patients of over 70 years of age. The most important points of the discussion are addressed.