Comparative Analysis of Laparoscopic Cholecystectomy Performed in the Elderly and Younger Patients: Should We Abstain from Laparoscopic Cholecystectomy in the Elderly?

Ekici, Uğur; Yılmaz, Serhan; Tatlı, Faik

doi:10.7759/cureus.2888

Cited by 10 publications

(15 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, others have reported mortality associated with cholecystectomy to be related to associated co-morbid conditions and fraility of the individual. Laparoscopic cholecystectomy in large series in elderly have been shown to be safe 2425. However, caution should be observed in every cholecystectomy as a potential to cause bile leak and its consequence.…”

Section: Discussionmentioning

confidence: 99%

Post-cholecystectomy acute injury: What can go wrong?

Gupta

Yadav

et al. 2019

Ann Hepatobiliary Pancreat Surg

View full text Add to dashboard Cite

Backgrounds/Aims Most of the emphasis of postcholecystectomy injuries is laid on iatrogenic bilary trauma. However, they can involve a wide spectrum of injuries. Methods We prospectively evaluated 42 patients with postcholecystectomy injuries referred to us from July 2011 to December 2012. Based on spectrum of injuries, we proposed an algorithm of management. Results Injuries occurred following laparoscopy in 20 (2 converted) patients and open in 22 patients. Mean time of detection of injury was 4.32±2.33 days. The nature of drainage was bilious in 36, bile with blood in 2, only blood in 2, and enteric in 2. Nine had organ failure at presentation. Six (14%) needed re-operation. Source of hemorrhage was from right hepatic artery in three and small bowel mesentry in 1. Enteric injuries were one each to duodenum and colon. Six patient (14%) died. Advancing age and organ failure were the predictors of mortality. Persistant biliary fistula was seen in 5 (14%). Ten had lateral leaks that closed at 28.89±2.34 days. Twenty-two formed stricture which was successfully managed with definitive hepaticojejunostomy. Conclusions Post cholecystectomy acute injury does not limit itself to bile duct or vascular injury but it can traumatize adjacent hollow viscus or mesentery. It is important to diagnose and intervene enteric injury early. Presentation and management for such injury should be followed as per the proposed algorithm.

show abstract

Section: Discussionmentioning

confidence: 99%

Post-cholecystectomy acute injury: What can go wrong?

Gupta

Yadav

et al. 2019

Ann Hepatobiliary Pancreat Surg

View full text Add to dashboard Cite

show abstract

“…) shows highly statistically significant higher complication in difficult group compared to essay group (p<0.001); Table(9) shows that age, gender, indication, ASA, gallbladder wall and Pre-Operative ERCP have a significant effect on the difficulty.Table(9): Multivariable binary logistic regression model analysis using the difficulty vs. patients as the dependent variable and the age, gender, indication, ASA, Gallbladder wall and ERCP as the independent variable in patients group…”

mentioning

confidence: 90%

A Prospective Study of the Incidence of Conversion of Laparoscopic Cholecystectomy to Open Cholecystectomy in 100 Patients

Grace¹,

Kamel

Rafik

et al. 2021

Ain Shams Medical Journal

View full text Add to dashboard Cite

Background: Laparoscopic cholecystectomy is the gold standard treatment for symptomatic gallstones. Conversion to an open procedure is necessary in 5-10% of patients.The aim of work: The present study was to illustrate the incidence of conversion of laparoscopic cholecystectomy to open cholecystectomy & to validate the efficacy of "CLOC" (Conversion from Laparoscopic to open cholecystectomy) risk scoring system on the patients included in the study.Patients and methods: The present observational prospective study was conducted in EL-Demerdash Teaching Hospital (January 2019-January 2020). The study included (100) symptomatic cholelithiasis patients. Patients were divided into two groups, firstly those who completed laparoscopic cholecystectomy and secondly those who were converted into open cholecystectomy. Preoperative variables included patient demographics, indications for surgery, ASA grade, admission type, ultrasound findings and preoperative endoscopic retrograde cholangiopancreatography (ERCP). Validation of the "CLOC" scoring system was applied to all patients. Operative data were gathered prospectively, and the difficulty of the procedure was graded using the Nassar scale (grades 1-4).Results: (24%) of patients recorded difficult total score; open surgery was conducted in (5%). There was statistically significant relation between CLOC risk scoring level and age (p<0.001); indication (p=0.002); ASA (p=0.002); gallbladder wall thickness. (p<0.001) and preoperative ERCP patients (p=0.003). There was statistically significant increase in difficulty in male compared to female. (p=0.019). There was actual conversion according to groups with 'high risk scoring >7 and conversions in the' low risk >6 easy' group below. (p=0.042); highly statistically significant increase of mean in difficult group compared to essay group (p<0.001). The difficult group complications rate was higher than the easy group (75% versus 10.5%); gallbladder rupture was mostly reported in (37.5% and 2.6%) of difficult group and easy group cases, respectively. Receiver operating characteristics (ROC) curve sensitivity was 92%; specificity was 98.7%. Age, gender, indication, ASA, gallbladder wall and Pre-Operative ERCP have a significant effect on the difficulty. Conclusion:The present study could conclude that parameters as older age, male gender, cholecystitis, ASA, thick wall GB, preoperative ERCP are predictors for difficult LC. Meanwhile these

show abstract

“…Традиційна холецистектомія (ТХЕ) в більшості випадків є досить травматичним втручанням, особливо для пацієнтів у віці 60 років і старше, і часто протягом післяопераційного періоду ускладнюється розвитком декомпенсованої стадії супутніх захворювань [4]. Розвиток малоінвазивних технологій дозволило виконувати адекватний обсяг операції при мінімальній операційній травмі, що значно поліпшило результати лікування даної патології у геріартрічних пацієнтів [5,6].…”

Section: вступunclassified

Nature of Post-Surgery Complications After Cholecystectomy of Destructive Cholecystitis in Patients of an Older Age Group With a Ischemic Heart Disease

Bondariev¹,

Markulan²,

Ivantsok³

et al. 2020

Khark. Surg. Sch.

View full text Add to dashboard Cite

Аbstract. The significance of the problem of acute cholecystitis in the elderly and senile is due to a high increase in the incidence, the presence of marked concomitant diseases. There is no literature data on a comparative analysis of early post-surgery complications of acute destructive cholecystitis in elderly and senile patients with concomitant coronary heart disease after traditional cholecystectomy and laparoscopic cholecystectomy. The Aim of the study is a comparative analysis of the nature of early post-surgery complications after traditional cholecystectomy and laparoscopic cholecystectomy of acute destructive cholecystitis in the elderly and senile with concomitant coronary heart disease. Materials and methods of research. A comparative analysis of early post-surgery complications was performed in 392 patients aged 60 and over with concomitant coronary heart disease who underwent surgical treatment for acute destructive cholecystitis. Depending on the method of surgical treatment, patients were divided into two groups: the І group (n = 178) — surgical treatment was carried out in the amount of traditional cholecystectomy, sanitation of the abdominal cavity with saline and decasan solution; the ІІ group (n = 214) — surgical treatment included laparoscopic cholecystectomy, sanitation of the abdominal cavity with saline and «decasan» solution, extraction of the gallbladder in a rubber sterile container through a subxiphoid wound, which, after removal of the gallbladder, was sanitized with «decasan» solution. Research results. Complications from the cardiovascular system in the 1st group were noted in 2.8 % of patients, pneumonia — 1.1 %, from the abdominal cavity — 8.5 %, wounds — 25.8 %, postoperative intestinal paresis — 19, 1 %, mortality — 1.1 %. In the 2nd group, complications from the cardiovascular system — 0.5 %, from the abdominal cavity — 4.7 %, wounds — 4.2 %, postoperative intestinal paresis — 8.4 %, mortality — 0.5 %. Complications related to bile leakage, the development of biloma or biliary peritonitis in the groups did not differ. Conclusions. The use of laparoscopic cholecystectomy in acute destructive cholecystitis in elderly people with concomitant coronary heart disease has reduced the number of postoperative complications from the cardiovascular system compared with traditional cholecystectomy from 2.8 % to 0.5 %, from the abdominal cavity — from 8.5 to 4.7 %, from the side of the wound — from 25.8 to 4.2 %, reduce mortality from 1.1 to 0.5 %.

show abstract

Comparative Analysis of Laparoscopic Cholecystectomy Performed in the Elderly and Younger Patients: Should We Abstain from Laparoscopic Cholecystectomy in the Elderly?

Cited by 10 publications

References 23 publications

Post-cholecystectomy acute injury: What can go wrong?

Post-cholecystectomy acute injury: What can go wrong?

A Prospective Study of the Incidence of Conversion of Laparoscopic Cholecystectomy to Open Cholecystectomy in 100 Patients

Nature of Post-Surgery Complications After Cholecystectomy of Destructive Cholecystitis in Patients of an Older Age Group With a Ischemic Heart Disease

Contact Info

Product

Resources

About