Comparison of Emergency and Elective Laparoscopic Cholecystectomy in Geriatric Patients

Abstract

GİRİŞLaparoskopik kolesistektomi (LK) safra kesesi hastalığının tedavisinde altın standarttır. LK'nin daha az ağrı, iyileşmenin kısalması, operatif stresin azalması, sınırlı inflamatuar yanıt, düşük komplikasyon, daha kısa hastanede kalış süresi ve düşük maliyetli olması gibi bazı avantajları vardır (1, 2). Bütün bu avantajlara rağmen cerrahlar geriatrik hastalarda laparoskopik cerrahi yaklaşımda isteksiz davranmakta ve sıklıkla konservatif yaklaşımları tercih etmektedirler (3). Geriatrik hastalara karşı bu savunmacı yaklaşım sıklıkla akut veya kronik tekrarlayan kolesistit, hidrops, ampiyem ya da perforasyon ile kendini göstermektedir (3, 4). Safra taşlarının sıklığı yaşla birlikte artar (5). Günümüzde 65 yaş üstü geriatrik hastaların oranı artıkça LK oranlarının da artacağı tahmin edilmektedir (5). Geriatrik hastalarda yandaş hastalıklar ve sınırlı fonksiyonel kapasite, peri ve post-operatifkomplikasyonlar için önemli risk faktörleridir (6).Bu araştırmanın amacı elektif ve acil LK uygulanan 65 yaş ve üstü geriatrik hastalarda postoperatif sonuçların değerlendirilmesidir. AbstractObjective: While the incidence of cholelithiasis increases with age, laparoscopic cholecystectomy (LC) has been more frequently performed in geriatric patients in recent years. This study aimed to analyze the results of elective and emergency LC. Methods: Medical records of patients aged over 65 years who underwent elective and emergency LC between January 2014 and December 2016 were retrospectively analyzed. Results: There were 119 patients; of these, 46 (38.7%) underwent emergency LC (emergency LC group) and 73 (61.3%) underwent elective LC (elective LC group). The conversion rate was 5.9%, and there was no difference between the groups (p=0.177). The mean age of the patients and duration of operation were 70.3 years and 86 min, respectively, and there was no difference between the groups. The hospitalization duration in patients in the elective LC group was shorter than that of those in the emergency LC group (2.11 versus 3.15 days, p=0.0001). Post-operative complications were seen in 9 patients in the elective LC group and 6 patients in the emergency LC group and showed no significant difference. One patient died in the elective LC group. Conclusion: Emergency LC in geriatric patients resulted in a longer hospitalization duration. However, it can be safely performed with low morbidity and mortality rate. Advanced age is not a contraindication for undergoing LC.