2017 WSES and SICG guidelines on acute calcolous cholecystitis in elderly population

Michele Pisano, Marco Ceresoli, Stefania Cimbanassi, Kurinchi Gurusamy, Federico Coccolini, Giuseppe Borzellino, Gianluca Costa, Niccolò Allievi, Bruno Amato, Djamila Boerma, Pietro Calcagno, Luca Campanati, Fabio Cesare Campanile, Alberto Casati, Osvaldo Chiara, Antonio Crucitti, Salomone di Saverio, Marco Filauro, Francesco Gabrielli, Angelo Guttadauro, Yoram Kluger, Stefano Magnone, Cecilia Merli, Elia Poiasina, Alessandro Puzziello, Massimo Sartelli, Fausto Catena, Luca Ansaloni, Michele Pisano, Marco Ceresoli, Stefania Cimbanassi, Kurinchi Gurusamy, Federico Coccolini, Giuseppe Borzellino, Gianluca Costa, Niccolò Allievi, Bruno Amato, Djamila Boerma, Pietro Calcagno, Luca Campanati, Fabio Cesare Campanile, Alberto Casati, Osvaldo Chiara, Antonio Crucitti, Salomone di Saverio, Marco Filauro, Francesco Gabrielli, Angelo Guttadauro, Yoram Kluger, Stefano Magnone, Cecilia Merli, Elia Poiasina, Alessandro Puzziello, Massimo Sartelli, Fausto Catena, Luca Ansaloni

Abstract

Background: Gallstone 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.

Aim: The 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 methods: The 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.

Results: The 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 conclusions: The 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.

Keywords: Acute calcolous cholecystitis; Antibiotics; Diagnosis; Elderly; Frailty; High-risk patients; Surgery.

Conflict of interest statement

Not applicable.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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