As the mean age of the population in our country has steadily incresed, the medical as well surgical problems in elderly patients, age over 70, are accordingly increased. Surgery for gallstone disease in this population have also been a matter
of
serious considerations.
An eleven-year retrospective review of 60 patients of elderly gallstone desease seen from January 1, 1980 to December 31, 1990, was undertaken at the depatment of surgery of Soon Chun Hyang University. This study focused on the clinical
presentations,
surgical management, postoperative complications and mortalities, and the risks and benefits of elective versus emergency surgery in the elderly.
The was 33 women and 27 men in the study ranging in age from 70 to 84. Elective procedures were performed in (51/60) 85 per cent of the patients while (9/60) 15 per cent underwent emergency surgery. Elective procedures were performed in (29/33)
87
per
cent of the women and (22/27) 81 per cent of the men. Gallbladder empyema, the most common complication of acute cholecystitis, was found in 10 cases of elective group and 6 cases of emergency group. The incidence of positive culture from the
bile
was
68.4% per cent of the elective cases and 100 per cent of the emergency. Complications developed in (25/ 51) 49 per cent of the elective cases and (8/9) 88.9 per cent of the emergency cases. Among the 60 patients in this series, there was 1.7 per
cent
mortality. Sepsis with multiple organ failure accounted for one death. In mean duration of hospitalization after operation, there was 19.1 days in elective group and 23.2 days in emergency group.
In conclusion, the elderly patients had higher operational risk factors, postoperative complications and mortalities in the emergency setting. Thus, the early elective surgical managements of symptomatic gallstone disease in elderly patients are
necessary to reduce the higher complications and mortalities of emergency surgery in this population.
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