Laparoscopic Cholecystectomy for Acute Cholecystitis in the Elderly

Kirshtein, Boris; Bayme, Michael; Bolotin, Arkady; Mizrahi, Shlomo; Lantsberg, Leonid

doi:10.1097/sle.0b013e318171525d

Cited by 72 publications

(41 citation statements)

References 31 publications

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“…Laparoscopic cholecystectomy has become the preferred approach in patients with acute cholecystitis [93][94][95][96][97][98][99][100][101] [99,[115][116][117][118][119][120][121]. Laparoscopic cholecystectomy in the elderly (age [ 65 years) may be associated with higher morbidity and mortality [122,123].…”

Section: Acute Cholecystitismentioning

confidence: 99%

SAGES guidelines for the clinical application of laparoscopic biliary tract surgery

et al. 2010

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Section: Acute Cholecystitismentioning

confidence: 99%

SAGES guidelines for the clinical application of laparoscopic biliary tract surgery

et al. 2010

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“…There are studies that have reviewed outcomes in elderly patients undergoing a cholecystectomy 17,18 but there are few studies that have reviewed outcomes for elderly patients treated conservatively. In particular, there are sparse data on the rate of recurrent AC in elderly patients.…”

mentioning

confidence: 99%

Patient outcomes after treatment with percutaneous cholecystostomy for biliary sepsis

Flexer

Peter

Durham-Hall

et al. 2014

annals

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1 Bradford Teaching Hospitals NHS Foundation Trust, UK 2 Doncaster and Bassetlaw Hospitals NHS Foundation Trust, UK ABSTRACT INTRODUCTION Acute cholecystitis is among the most common general surgical presentations. There is a cohort of patients who develop systemic sepsis and complications of acute cholecystitis. These patients are often elderly and co-morbid. Conservative management with percutaneous cholecystostomy has been shown to be a safe and effective management option in the acute setting. However, there is currently no consensus for the further management of these patients. In particular, there is a paucity of data on readmission rates and subsequent operative or non-operative management. METHODS A retrospective study was carried out of patients treated with a percutaneous cholecystostomy for biliary sepsis over a three-year period in a UK teaching hospital. Outcome measures were subsequent operative or conservative management, conversion rates, operative complications and readmission rates. RESULTS Twenty-five patients had a percutaneous cholecystostomy for the treatment of acute biliary sepsis. The median follow-up duration was 35 months. Thirteen patients (52%) had operative treatment. In the operative group, 6/13 had a laparoscopic cholecystectomy, 2/13 had a planned open cholecystectomy, 2/13 had abandoned procedures and 3/13 had a converted procedure. Complications in the operative group included: postoperative mortality (1/13), common bile duct injury requiring drainage and endoscopic stenting (1/13) and one patient required readmission with recurrent pain. In the non-operative group, 5/12 patients were readmitted with biliary sepsis, 5/12 had no readmissions, 1/12 died in the community and 1/12 was readmitted with biliary colic. CONCLUSIONS Percutaneous cholecystostomy is a recognised treatment modality for elderly, co-morbid patients with biliary sepsis. Nevertheless, the readmission rate in this group is relatively high at 5/12 (42%). Patients who undergo subsequent operative management have a conversion rate of 3/13 (23%) and a significant complication rate of 2/13 (15%). The further management of patients having undergone percutaneous cholecystostomy requires careful consideration on an individual case basis. The P-POSSUM (Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity) may aid decision making.

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“…[11,12] Laparoskopik kolesistektomi ile dahi, ileri yaş grubunda olan ve ciddi komorbiditeleri bulunan olgularda acil cerrahi sonrasında %41'e ulaşan morbidite ve %4.8'e ulaşan mortalite oranları saptanmıştır. [13][14][15] Laparoskopik kolesistektomiden açık cerrahiye konversiyon oranları da, akut kolesistitli yaşlı olgularda %32 gibi yüksek düzeylerde bildirilmiştir. [13] USG kılavuzluğunda PK, deneyimli ellerde, kolay ve hızlı uygulanabilen bir yöntem olup, literatürde yüksek teknik başarı (%94-100) ve düşük morbidite (%0-18) ve mortalite (%0-3) oranları bildirilmektedir.…”

Section: Discussionunclassified

The role of percutaneous cholecystostomy in the management of geriatric patients with acute cholecystitis

Semiz-Oysu¹,

Macin²,

Şişik³

et al. 2012

Istanbul Tip Derg

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Laparoscopic Cholecystectomy for Acute Cholecystitis in the Elderly

Abstract: LC in elderly patients suffering from acute cholecystitis is feasible and effective. It is associated with a higher rate of morbidity unrelated to the surgical site and mortality in elderly compared with younger patients. Stronger selection of elderly patients for surgery is needed.

Cited by 72 publications

References 31 publications

SAGES guidelines for the clinical application of laparoscopic biliary tract surgery

SAGES guidelines for the clinical application of laparoscopic biliary tract surgery

Patient outcomes after treatment with percutaneous cholecystostomy for biliary sepsis

The role of percutaneous cholecystostomy in the management of geriatric patients with acute cholecystitis

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