Cholecystectomy (or the removal of the gallbladder) is the most performed abdominal surgery in the world, but it is not always easy to perform, especially in urgent cases and in elderly patients who are often fragile. The ageing of society in fact determines the presence of elderly patients with fragility, dictated for example by the consumption of many drugs, the concomitance of diabetes, immunodepression, cardiovascular problems, and conditions that risk complicating an emergency surgery.

How is emergency surgery handled in an elderly and frail patient? In Humanitas, a collaboration between emergency surgery and endoscopy has proven to be essential, for example in the case of acute cholecystitis. We talk about this issue with Dr. Hayato Kurihara, Head of Emergency Surgery and Trauma and Dr. Andrea Anderloni, Head of the section of Operational Bilio-Pancreatic Endoscopy.


A shared path in emergency surgery

Dr. Kurihara explains: “The need for urgent surgery for fragile patients, such as acute cholecystitis, means that a rapid decision must be made on how to intervene, and it is not always easy to discuss with other specialists.

At Humanitas we are working on the creation of a diagnostic and therapeutic path with a multidisciplinary approach for patients in emergency surgery. Thanks to the collaboration with Dr. Anderloni and the development of this new endoscopic treatment, we can operate on fragile patients with acute cholecystitis without exposing them to the risk of general surgery.

The European Society for Trauma & Emergency Surgery of which I am a member, during its annual International Congress held from 7 to 9 May in Bucharest, also invited Dr. Anderloni, precisely to deepen this necessary dialogue between endoscopy and emergency surgery and to present this new endoscopic technique”.


What is endoscopic drainage of cholecysts?

“It is an innovative and minimally invasive approach to the treatment of acute cholecystitis,” says Dr. Anderloni. In the past, this was done with external surgical or radiological drainage, a procedure not free of complications (about 25%) and that caused discomfort for the patient, given the necessary coexistence with a small tube that came out of the abdomen.

Now, thanks to eco-endoscopy, we are able to drain the prosthesis by placing it inside the body, thus reducing discomfort for the patient.

We position a new metal prosthesis (stent) that connects the intestinal or gastric lumen with the collection to be drained by means of an ecoendoscopy (ultrasound applied to endoscopy). This technique can also be used to treat acute cholecystitis in frail patients, for example elderly patients with major comorbidity (cardiovascular, kidney, lung disease or diabetes), who are not susceptible to surgical treatment. In this case we detect the inflamed gallbladder, place the stent (self-expanding and covered) and empty the gallbladder from inside.


The advantages of ecoendoscopy

The development of this technique is part of the effort to find increasingly effective and less invasive therapies, to the benefit of the patient. Ecoendoscopy is minimally invasive, safe and fast (in some cases the patient begins eating on the same evening as the operation), does not require external drainage and reduces the risk of complications.

In addition, the first data available in the literature also point to a potential reduction in the days of hospitalization for these patients, thus allowing a faster recovery of normal habits for the patient.

Humanitas is one of the leading centers in Italy in the use of this technique and it is part of a European board of 12 centers for the further development of this procedure and its devices. On Monday, May 15 in Humanitas, Dr. Anderloni made the first intervention in Italy with a new larger device (a stent of 20 millimeters in diameter), which was broadcasted live throughout Europe.