Recent rapid increases in the aging population have created an impending “silver tsunami” in developed countries. Indications for surgical treatments in this population are a serious issue because most older patients have multiple concomitant systemic diseases. The incidence of gallstone disease is especially high among the older population, and the indications for treatment, including surgical procedures, are complicated. Gallstone disease is one of the most common and costly digestive diseases associated with aging. The current standard of care for patients presenting with cholecystolithiasis is early elective cholecystectomy to reduce gallstone-related complications (G-RCs) and medical costs. Although laparoscopic cholecystectomy is the best modality for gallstone disease, its safety in geriatric patients remains controversial because of multiple competing risks.

Age is an independent predictor of poorer outcomes after cholecystectomy . Associated chronic illness increases the morbidity and mortality of elective cholecystectomy. Many older patients may have a limited life expectancy because of comorbidities and may succumb to chronic medical conditions, such as heart disease, before developing symptoms of gallstone disease. Older patients also have an increased risk of developing G-RCs . Unless the expected life span is short, cholecystolithiasis and subsequent choledocholithiasis are likely to recur. Indeed, a meta-analysis that compared cholecystectomy after endoscopic sphincterotomy (EST) versus a wait-and-see approach showed a significantly higher risk of biliary complications and death in the latter group . Once biliary complications occur, treatment-related morbidity and mortality rates significantly increase in this vulnerable population. However, management of older patients who present with symptomatic cholecystolithiasis has not been well described. Surgeons have recently become more aggressive in treating gallstone disease, especially in older patients. Despite this trend, many patients continue to be treated non-operatively.

Because the selection criteria for non-operative management may have changed, the effect of this approach needs to be reinvestigated. This study aimed to compare the outcomes of cholecystectomy versus a wait-and-see approach in patients aged ≥75 years with cholecystolithiasis. They also examined predictors of the requirement for elective cholecystectomy after an episode of symptomatic cholecystolithiasis in this older population.

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Regards,

Jessica Celina

Managing editor

Pancreatic Disorders and Therapy