La colecistite acuta nell’ultrasettantenne (Acute cholecystitis in patients over 70 years old).

Gallstone disease is the most com- mon surgical indication in the elderly. Post- operative prognosis is severe in elderly with acute cholecystitis. Aim of this paper is to inve- stigate the factors responsible for the severe prognosis and to detect how it could be impro- ved. Methods. Onehundredfifty-seven patients, aged between 70 and 85 years (average 82 years), undergoing cholecystectomy between the years 1990 and 2000 have been studied; 65 patients (group A) had acute cholecystitis; 92 (group B) had uncomplicated gallbladder stones. Results. Acute cholecystitis was the first symp- tom of gallstone disease in Laparo- cholecystectomy was performed in 31 cases (47.6%) of group A and in 58 cases (63.7%) of group B. In those cases with acute cholecysti- tis the postoperative morbidity (18.4%) was higher than in group B (1.0%), B: p<0.001). Similarly, postoperative mortality was higher (6.1% vs 1.0%; p<0.05) The severe postoperative prognosis was correlated significantly to index vs IV: p<0.001) but not to the technique adopted for cholecystectomy open: p=n.s.). The results obtained seem to confirm that the high incidence of postoperative complications in acute cholecystitis is due to the presence of associated diseases in elderly patients accom- panied by the septic state. Conclusions. Early colecystectomy, in those cases with symptomatic, uncomplicated stone disease, might avoid severe postoperati- ve prognosis in the elderly.