Gallstone disease in patients over the age of 80. Surgery or long-term medical treatment?

OBJECTIVE: Growth in the geriatric population is increasing the biliary pathology of the elderly, thus becoming more frequent in the medical environment. The different therapeutic methods that are at present in use, should be applied to this group, employing open cholecystectomy as a reference. MATERIAL AND METHODS: During a period of 5 years we have attended 209 patients over the age of 80 (13.8 of the total of gallstones), 76 patients (36.4%) underwent surgery and in 133 cases (63.6%) another therapeutic method was decided upon. The progression, complications and mortality rate are studied closely herein. RESULTS: The majority, 156 (74.6%) were not previous admissions and in 108 (51.7%) the symptoms had been present for less than one month. Eighty four (40.2%) were suffering from jaundice on admission (on average 4 days) and 89 (42.6%) showed signs of inflammation. 23 patients (11%) were submitted only to an endoscopic sphincterotomy. Of those patients who underwent surgery, 52 (67.5%) had a range of inflammatory phenomena. Open cholecystectomy was carried out on 65 patients (85.5%). Sixty one patients (29.2%) presented complications, 38 (50%) in the group underwent surgery. Twenty eight patients (13.4%) died-9 (11.8%) of the 76 patients were operated upon. CONCLUSIONS: Elderly patients can undergo surgery in selected cases with an acceptable mortality rate and high morbidity. Surgery is recommended in those of a lesser age, not always possible as many of them lacked prior symptoms.