Abstract
BackgroundGallstone disease is very common afflicting 20 million people in the USA. In Europe, the overall incidence of gallstone disease is 18.8% in women and 9.5% in men. The frequency of gallstones related disease increases by age. The elderly population is increasing worldwide.AimThe present guidelines aims to report the results of the World Society of Emergency Surgery (WSES) and Italian Surgical Society for Elderly (SICG) consensus conference on acute calcolous cholecystitis (ACC) focused on elderly population.Material and methodsThe 2016 WSES guidelines on ACC were used as baseline; six questions have been used to investigate the particularities in elderly population; the answers have been developed in terms of differences compared to the general population and to statements of the 2016 WSES Guidelines. The Consensus Conference discusses, voted, and modified the statements. International experts contributed in the elaboration of final statements and evaluation of the level of scientific evidences.ResultsThe quality of the studies available decreases when we approach ACC in elderly. Same admission laparoscopic cholecystectomy should be suggested for elderly people with ACC; frailty scores as well as clinical and surgical risk scores could be adopted but no general consensus exist. The role of cholecystostomy is uncertain.Discussion and conclusionsThe evaluation of pro and cons for surgery or for alternative treatments in elderly suffering of ACC is more complex than in young people; also, the oldest old age is not a contraindication for surgery; however, a larger use of frailty and surgical risk scores could contribute to reach the best clinical judgment by the surgeon. The present guidelines offer the opportunity to share with the scientific community a baseline for future researches and discussion.
Highlights
IntroductionIn Europe, the overall incidence of gallstone disease is 18.8% in women and 9.5% in men
Gallstone disease is very common afflicting 20 million people in the USA
Same admission laparoscopic cholecystectomy should be suggested for elderly people with acute calculus cholecystitis (ACC); frailty scores as well as clinical and surgical risk scores could be adopted but no general consensus exist
Summary
In Europe, the overall incidence of gallstone disease is 18.8% in women and 9.5% in men. The frequency of gallstones related disease increases by age. Gallstone disease is very common afflicting 20 million people in the USA [1, 2]. The overall incidence of gallstone disease was 18.8% in women and 9.5% in men [3]. Untreated gallstones may lead to acute calculus cholecystitis (ACC) in 10% to 20% of people [7]. Other complications of gallstones include common bile duct stones and acute pancreatitis. In patients in whom cholecystectomy was not performed at the initial admission for ACC, the probabilities of gallstone-related complications are 14%, 19%, and 29% at 6 weeks, 12 weeks, and at 1 year, respectively [8]
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