Is Early Laparoscopic Cholecystectomy Feasible for Acute Cholecystitis in the Elderly?
Abstract
AIM: We r evi ewed our expe r i enc e wi th l apa ros copi c cholecystectomy (LC) in patients with acute cholecystitis to assess feasibility of early LC (within 72 hours of the onset of symptoms) in the elderly. METHODS: A total of 111 consecutive patients with acute cholecystitis who intended to undergo LC between 2004 and 2008
were reviewed. We used our therapeutic strategy flowchart in accordance with the severity of acute cholecystitis and concomitant surgical risks to select patients suitable for early LC. The severity of
acute cholecystitis, presence of preoperative surgical risk, American Society of Anesthesiologists score and other preoperative surgical risk scores, feasibility of early LC done, and outcome of both early and delayed LC in patients 70 years of age and older (Group 1) were compared to those in patients younger than 70 years (Group 2). RESULTS: The severity of acute cholecystitis in Group 1 and Group 2 were as follows; Grade I: 31% vs 45%, Grade II: 49%vs 44%, Grade III: 20% vs 11%, p=0.17). Patients in Group 1 had higher occurrence of preoperative surgical risk, including high rate of antithrombotic use (35%), than those in Group 2 (53% vs 24%,p=0.002). The rates of early LC were similar between the groups(55% vs 47%). Concerning early LC, There were no differences between the two groups, in the conversion rates (4% vs 5%), duration of surgery (120 min vs 125 min), estimated blood loss (81 g vs 88 g), length of postoperative stay (8.0 d vs 6.0 d). There was neither operative death nor severe biliary injury in each group. CONCLUSION: Our results showed that early LC was intended and performed in 55% of elderly patients suffering from acute cholecystitis, with minimal postoperative complications and low conversion rate to open cholecystectomy. Early LC is a safe,effective treatment for acute cholecystitis even in the elderly if an appropriate patient selection is secured.
were reviewed. We used our therapeutic strategy flowchart in accordance with the severity of acute cholecystitis and concomitant surgical risks to select patients suitable for early LC. The severity of
acute cholecystitis, presence of preoperative surgical risk, American Society of Anesthesiologists score and other preoperative surgical risk scores, feasibility of early LC done, and outcome of both early and delayed LC in patients 70 years of age and older (Group 1) were compared to those in patients younger than 70 years (Group 2). RESULTS: The severity of acute cholecystitis in Group 1 and Group 2 were as follows; Grade I: 31% vs 45%, Grade II: 49%vs 44%, Grade III: 20% vs 11%, p=0.17). Patients in Group 1 had higher occurrence of preoperative surgical risk, including high rate of antithrombotic use (35%), than those in Group 2 (53% vs 24%,p=0.002). The rates of early LC were similar between the groups(55% vs 47%). Concerning early LC, There were no differences between the two groups, in the conversion rates (4% vs 5%), duration of surgery (120 min vs 125 min), estimated blood loss (81 g vs 88 g), length of postoperative stay (8.0 d vs 6.0 d). There was neither operative death nor severe biliary injury in each group. CONCLUSION: Our results showed that early LC was intended and performed in 55% of elderly patients suffering from acute cholecystitis, with minimal postoperative complications and low conversion rate to open cholecystectomy. Early LC is a safe,effective treatment for acute cholecystitis even in the elderly if an appropriate patient selection is secured.
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