Gallstones and cholecystitis

Asymptomatic gallstones are a common feature of ageing as time, gall bladder dysfunction and the increasing lithogenicity of bile seem to predispose the gall bladders of the more elderly population to precipitation of supersaturated bile and the concomitant crystallisation of cholesterol or calcium bilirubinate into stone material. While it has been accepted dogma that prophylactic surgery should not be recommended in asymptomatic patients, the longer one has gallstones, the more likely one is to develop cholecystitis and biliary colic. The dilemma clinicians and surgeons encounter is tackling this problem and arriving at the decision on whom to operate and the timing of surgery.

Most patients with gallstones never develop acute cholecystitis, and among those who experience an episode of biliary colic, nearly half will never experience a second episode of colic within five years. Such an outcome could justify a “wait-and-see” approach for most elderly patients. However, there are several factors which contradict such a decision in the aged. Firstly, the presentation of colic in the elderly patient …