The Safety of Minimally Invasive and Open Cholecystectomy in Elderly Patients With Acute Cholecystitis: A Systematic Review

Elderly patients with acute cholecystitis (AC) often receive no surgical treatment due to a high number of comorbidities and a high risk of operations. With an increasingly aged population worldwide, this systematic review aims to review the safety of minimally invasive cholecystectomy and open cholecystectomy in this population compared to younger patients. A systematic search was conducted on PubMed, PubMed Central, and Google Scholar databases on July 2, 2022. Articles in the English language published in the last five years with free full text and involving elderly patients with AC treated with minimally invasive and open cholecystectomy were selected. Moreover, a quality assessment was carried out by using each study's most commonly used assessment tools. Initially, the search yielded 1,252 potentially relevant articles. After the final selection process, 11 studies were included: one cross-sectional study, eight cohort studies, one case-control study, and one systematic review with meta-analyses. These studies involved a total of 378,986 participants, with 375,623 elderly patients. In the elderly, cholecystitis severity, decreased physical status, and multiple comorbidities increase the risk of complications with cholecystectomy. In addition, the elderly had more complications, open surgery conversions, biliary tract injuries, leaks, postoperative mortality, and hospital length of stay than younger patients. Nevertheless, minimally invasive cholecystectomy is a viable treatment option for elderly patients when performing a thorough perioperative assessment.