Complications of laparoscopic cholecystectomy in the ageing patient

Abstract

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.

Laparoscopic partial cholecystectomy: A safe and effective alternative surgical technique in "difficult cholecystectomies"

“…Studies suggested that LC was safe, did not increase complication rates, shortened the time of hospitalization, and was associated with a marked improvement in the quality of life for the elderly. Surgeons were recommended to complete an operation in the laparoscopic setting as much as possible in patients with advanced age (12,(21)(22)(23)(24)(25). In our study, the mean age did not significantly differ between the two groups.…”

Colecistectomia videolaparoscópica em 960 pacientes idosos

“…We note that conversion is related to the following situations: technical difficulty to dissect the structures of the biliary pedicle, acute cholecystitis, bleeding, iatrogenic injury to the bile duct 16,17 , choledocholithiasis, scleroatrophic gallbladder 5 and male gender with acute cholecystitis 15 . The difficulty of identification of anatomical structures has also been emphasized as a cause of conversion 18 . In this study, the causes of conversion were: little experience of the surgeon, with little training in the early years of the laparoscopic method; defect in equipment; choledocholithiasis perioperatively identified; calculi impacted in the papilla; multiple adhesions; severe acute cholecystitis; and sessile scleroatrophic gallbladder.…”

Laparoscopic Surgery in the Elderly: A Review of the Literature

“…Older patients are more likely to experience complications following laparoscopic cholecystectomy [15,16,17]. The overall rates of morbidity and mortality remain less with the laparoscopic technique versus open.…”