RESUMO
INTRODUCCIÓN. La colecistitis aguda (CA) en el anciano es una entidad clínica frecuente, caracterizada por la elevada tasa de complicaciones y mortalidad. La elección entre cirugía urgente o tratamiento conservador más cirugía diferida es un motivo de controversia. MATERIAL Y MÉTODOS. Estudio de una cohorte retrospectiva sobre pacientes con edad igual o superior a 70 años tratados de colecistitis aguda entre 2003 y 2009. Se analizaron parámetros epidemiológicos, clínicos, diagnósticos, quirúrgicos y de coste-efectividad. Método estadístico: utilizamos los test Chi-2, ôtõ de Student y ANOVA. El nivel de significación se estableció paravalores p < 0.05. RESULTADOS. Durante los 6 años estudiados fueron tratados 173 episodios de CA en 147pacientes (52 por ciento mujeres), con una edad media de 80.6 años (máximo 101). En 103 episodios (77 pacientes) se adoptó tratamiento médico de los que 31 se operaron de forma electiva conun 100 por ciento de abordajes laparoscópicos, baja tasa de conversión (6.4 por ciento) y morbilidad (9.6 por ciento) sin registrarse mortalidad. Otros 85 pacientes fueron intervenidos de urgencia con un 78.5 por ciento de abordajes laparoscópicos, tasa de conversión del 19.7 por ciento, morbilidad 53 por ciento y mortalidad 3.5 por ciento. CONCLUSIONES. Considerando todas las variables la cirugía urgente y el tratamiento médico seguido de colecistectomía electiva obtienen resultados similares, aunque los enfermos sometidos a colecistectomía laparoscópica precoz fueron los que mejor evolucionaron.
INTRODUCTION. Acute cholecystitis in elderly patients is a frequent disease characterized by a high mortality rate and serious complications. The choice between emergency surgery or conservative therapy in addition to delayed surgery is a controversial issue. PATIENTS AND METHODS. Retrospective cohort study over patients aged 70 years or older undergoing acute cholecystitis treatment between 2003 and 2009. Epidemiological, clinical, diagnostic, surgical and cost effectiveness parameters were analysed. Statistical method: Weuse Chi squared test, Student´s t test and ANOVA. A level of p < 0.05 was accepted as significant. RESULTS. During the six-year period studied 173 episodes of acute cholecystitis were treated on 147 patients (52 percent females), with an average age of 80.6 years (maximum 101). In 103 episodes(77 patients) medical treatment was taken, 31 of them undergone elective surgery by means of 100 percent laparoscopic approach, 6,4 percent conversion rate, 9,6 percent morbidity in absence of mortality. In other 85 patients emergency surgery was performed, 78.5 percent of them through laparoscopy approach with a conversion rate of 19.7 percent , 53 percent morbidity and 3,5 percent mortality. Conclusions. Taking into account all variables, emergency surgery and medical treatment followed by elective cholecistectomy get similar outcomes, making better progress those who underwent early laparoscopic cholecystectomy.
Assuntos
Idoso , Idoso de 80 Anos ou mais , Colecistectomia Laparoscópica , Colecistite Aguda , Colecistite/cirurgia , Complicações Intraoperatórias , Estudos RetrospectivosRESUMO
INTRODUCTION: Acute cholecystitis in elderly patients is a frequent disease characterized by a high mortality rate and serious complications. The choice between emergency surgery or conservative therapy in addition to delayed surgery is a controversial issue. PATIENTS AND METHODS: Retrospective cohort study over patients aged 70 years or older undergoing acute cholecystitis treatment between 2003 and 2009. Epidemiological, clinical,diagnostic, surgical and cost-effectiveness parameters were analysed. STATISTICAL METHOD: We use Chi squared test, Student's t test and ANOVA. A level of p < 0.05 was accepted as significant. RESULTS: During the six-year period studied 173 episodes of acute cholecystitis were treated on 147 patients (52% females), with an average age of 80.6 years (maximum 101). In 103 episodes (77 patients) medical treatment was taken, 31 of them undergone elective surgery by means of 100% laparoscopic approach, 6,4% conversion rate, 9,6% morbidity in absence of mortality. In other 85 patients emergency surgery was performed, 78.5% of them through laparoscopy approach with a conversion rate of 19.7%, 53% morbidity and 3,5% mortality. CONCLUSIONS: Taking into account all variables, emergency surgery and medical treatment followed by elective cholecistectomy get similar outcomes, making better progress those who underwent early laparoscopic cholecystectomy.