Colecistectomia videolaparoscópica em 960 pacientes idosos

Abstract

Results Results: operative time ranged from nine to 180 minutes. The length of stay ranged from 24 to 120 hours. Conversion occurred in 28 patients (2.92%), of which 67.9% were women and 28.6% men, a minilaparotomy having been performed in 11 cases (39.3%) and in 17 (60.7%) the conventional open route. The perioperative complications were two ruptures of the gallbladder, a failure in the pneumoperitoneum and in clipping of the cystic duct. Post-operative complications were five umbilical incisional hernias. Systemic complications were: nine arrhythmias, one postoperative jaundice, one acute myocardial infarction and one mesenteric infarction. Mortality occurred in three patients (0.3%), one due to perioperative myocardial infarction, one due to sepsis and one because of the mesenteric infarction. Conclusion Conclusion Conclusion Conclusion Conclusion: elderly patients undergoing laparoscopic cholecystectomy had low hospital stay and low morbimortality. The operative time and hospital stay were short, demonstrating that laparoscopic cholecystectomy is safe and effective in the elderly.

Comparison between open and laparoscopic elective cholecystectomy in elderly, in a teaching hospital

“…We believe that this divergence is due to under-reporting of minor complications. The conversion rate to open surgery in our series was 2.9%, compared with 2.5 to 14% in LC other series studying elective for symptomatic cholelithiasis in the elderly 4,[17][18][19][20][21][22][23][24][25][26] , being similar to the conversion rate in young patients 4,27,28 , unlike Qasaimeh et al 29 , who reported higher conversion rates in the elderly.…”

“…There is variability in global practices for the treatment of this disease in the elderly, and social, physiological and pathological characteristics of the elderly population also differ greatly between regions. In Brazil, there are few studies on the subject [19][20][21] . When one considers the population we studied (patients from SUS -National Health System) and procedures performed in the public system teaching hospitals, researches are even scarcer.…”

Cholecystectomy in octogenarians: recent 5 years' experience

“…Associated CBD stones causing cholangitis, pancreatitis, impending septic condition are frequently met in octogenarian patients as described above but reduced functional reserve resulting from extreme old age is additionally threatening patients before and after operative management. As being emphasized of highly increased operative risks by Loureiro et al 7 , Marcari et al 8 would even named octogenarians extremely old and should be seen as a different group. Tambyraja et al 9 also published high rate of complication of 22.0%, from 24.0% acute form of cholecystitis in octogenarians to put emphasis on serious level of morbidities.…”

Understanding the reasons for the refusal of cholecystectomy in patients with cholelithiasis: how to help them in their decision?

“…This study used a sample of patients that resembles the general population of patients with cholelithiasis 3 , 9 , 10 , 17 . The model is a qualitative study, based on analysis of interviews with pre-established script allowing to explore the causes that have led some patients to refuse or postpone the operation without justification.…”