In elderly patients (over 75 years of age) suffering from acute cholecystitis, laparoscopic cholecystectomy exhibits lower rates of readmissions and reinterventions compared to antibiotic therapy.

A study was conducted with the goal of comparing laparoscopic cholecystectomy (LC) with antibiotic treatment for acute cholecystitis.

A multicenter randomized clinical trial was carried out, involving individuals aged > 75 years diagnosed with acute calculous cholecystitis across 4 hospitals. They were randomly allocated to either receive antibiotic therapy or undergo LC. Additionally, a retrospective cohort study was conducted, encompassing all volunteers over 75 years diagnosed with acute cholecystitis within the study timeframe. Morbidity was the major endpoint under investigation, while predefined secondary endpoints included length of hospital stay, readmission rates, and mortality.

No differences were reported in the complication rates between LC and antibiotic therapy. In the group of 42 subjects who were randomly assigned to treatment (24 received LC, and 18 received antibiotics), with a mean age of 82 years and 43% being women, the complication rate was 17% (4 out of 24) after cholecystectomy and 33% (6 out of 18) after antibiotic treatment (with 5 out of 6 patients receiving cholecystectomy due to antibiotic treatment failure). In the retrospective cohort of 630 individuals, with a mean age of 83 years and 49% being women, 37% (236 out of 630) underwent cholecystectomy, while 63% (394 out of 630) received antibiotics.

The rate of hospital readmissions was lower following surgical treatment compared to antibiotic treatment in both the randomized and retrospective cohort groups (8% vs. 44% and 11% vs. 32%, respectively). There were no 30-day mortalities observed in the randomized trial, whereas the overall mortality in the retrospective patient cohort was 6% (35 out of 630 patients).

In elderly patients specifically diagnosed with acute cholecystitis, LC could potentially offer advantages over antibiotic therapy in acute cholecystitis patients.