A cholecystectomy, that is the removal of the gall bladder, is the most common abdominal surgery in the world. Nevertheless, it is not always easy to perform, especially in emergency and with frail, elderly patients. In fact, the aging of the population determines an increase in frail elderly patients, whose frailties depend, for instance on taking many medications and on the co-occurrence of diabetes, immunosuppression and cardiovascular issues. These conditions may complicate an urgent surgery, making it risky.

So, how should urgent surgeries be performed on frail elderly patients? The collaboration between emergency surgeon and endoscopy specialist is paramount at Humanitas, in the case of acute cholecystitis. We asked Doctor Hayato Kurihara, Supervisor of Emergency and Trauma Surgery, and Doctor Andrea Anderloni, Supervisor of the Bilio-Pancreatic Operative Endoscopy Section.

A shared course in urgent surgery

Doctor Kurihara explains, “Making frail patient undergo an urgent surgical operation, makes it necessary to figure out rapidly how to proceed. It is also difficult to ask for the opinion of other specialists.

At Humanitas, we are working towards the creation of a diagnosis and therapy course with a multidisciplinary approach for patients in urgent surgery. Thanks to the collaboration with Doctor Anderloni and to the development of this new endoscopic treatment, we can now operate frail patients with acute cholecystitis without exposing them to the risks of surgery.

I am a member of the European Society for Trauma & Emergency Surgery. During their annual International Meeting (Bucarest, 7-9 May), Doctor Anderloni spoke about the necessary communication between endoscopy and urgent surgery, and presented this new endoscopic technique”.

What is the endoscopic drainage of the gall bladder?

Doctor Anderloni says, “It is an innovative, minimally invasive approach to treat acute cholecystitis. In the past we used an external surgical or radiological drainage. A procedure that resulted in complications in 25% of the cases and caused discomfort in patients due to a tiny tube that came out of their abdomen.

Nowadays, echoendoscopy allows us to perform the drainage by putting prostheses inside the body, thus reducing the discomfort for patients.

Using echoendoscopy (echography applied to endoscopy) we put a new metal prosthesis (stent) that links the intestinal or gastric lumen with the mass to drain. This technique may also be used in frail patients, for instance elderly people suffering from co-occurring severe diseases (cardiovascular diseases, kidney diseases, lung diseases, diabetes) who would not respond well to surgeries. In this case, the surgeon locates the inflamed gall bladder, puts the stent (self-expandable and covered) in place, and drains the gall bladder from the inside”.

The advantages of echoendoscopy

The development of this technique is part of the research of increasingly effective and less invasive therapies. In fact, echoendoscopy is minimally invasive, safe and fast, does not need external drainage and reduces the risk of complications.

Moreover, the first data available highlight a reduction of occupant days for these patients, thus allowing a faster recovery of their usual life habits.

Humanitas is one among the leader centers in Italy for this technique. Also, it is part of a European board of 12 centers for the further development of this procedure and its devices. On Monday 15, May, Doctor Anderloni performed at Humanitas, the first surgery in Italy with a new larger device (a 20-millimeter stent), broadcasted live throughout Europe.