PYY concentration is lower in MO patients compared with non-obese. After VBG, PYY concentration gradually rises to the control levels.

Aim: to determine the safety of simple laparoscopic cholecystectomy in ageing patients. Method: the outcome of patients between 60 and 70 years of age and patients over 70 who underwent laparoscopic cholecystectomy for symptomatic non-malignant gallbladder disease was comparatively analysed. All patients over 60 years of age with symptomatic gallbladder disease and without cholecholithiasis, septic shock, diffuse peritonitis, gallbladder malignancy, portal hypertension or contraindication for general anaesthesia were selected for simple laparoscopic cholecystectomy (n = 158). This group represents over 80% of all elderly patients undergoing biliary surgery at our department over this period. Group A (n = 97) included patients from 60 to 69 years of age. Group B (n -61) comprised patients over 70 years. Results: there was no difference in sex distribution between groups. Operative time and conversion rates were similar in both groups. The overall morbidity rate was 14.5%, with no statistically significant increase in group B (11% for group Avs20% for group B). No perioperative mortality occurred. Recurrent biliary surgery was required in two patients from group B (3%). Postoperative endoscopic retrograde cholangiography and sphincterotomy was done in four patients from group A (4%). The mean postoperative stay was longer for older patients (group A, 3.1 (2.5) days; group B, 4.2 (4.3) days; i>=0.05). Conclusion: simple laparoscopic cholecystectomy is safe in the aged, even for patients over 70. This procedure is associated with a short hospital stay and low rates of re-admission and recurrent biliary surgery.

Background/Aim: The overall mortality rate in patients undergoing supraduodenal choledochotomy for benign biliary tract disease is around 3%. The aim of this study is to identify and quantify factors affecting the mortality in a group of patients undergoing open common bile duct exploration for benign biliary disease. Methods: Patients (n = 158) who underwent common bile duct exploration during a 5-year period in a teaching hospital were retrospectively reviewed. Results: Univariate and multivariate statistical analyses were performed. The former identified four statistically significant variables: age (p < 0.001), acute cholangitis on admission (p < 0.001), heart disease (p < 0.05), and a dilated common bile duct on preoperative ultrasound scan (p < 0.05). Multivariate analysis identified three variables which independently increased operative mortality: age (p = 0.05), heart disease (p = 0.03), and cholangitis (p = 0.008). The latter was associated with the greatest operative mortality, since it increased almost eight times the risk to die after surgical intervention. Conclusion: We conclude that an adequate perioperative cardiovascular management may be important in order to improve surgical outcome. Appropriate antibiotic prophylaxis and subsequent treatment after routine operative bile cultures may reduce septic complications and mortality. Finally, an alternative procedure, such as endoscopic sphincterotomy, may be indicated in high-risk patients in order to drain the common bile duct preoperatively and to decrease the risk of unresponsive biliary sepsis.

No abstract