[Cholecystectomy in the elderly: early results of open versus laparoscopic approach].
The rise of elderly population is due to the improvement of life expectancy. The biliary lithiasis is the most common condition requiring intra-abdominal surgery. Half of these patients sustain associated diseases and frequently develops acute and complicated forms of cholelithiasis. Therefore, cholecystectomy is indicated for patients with chronic symptomatic disease. During a long period open cholecystectomy has been practiced, with low complications and mortality rates. Videolaparoscopy has been recently proposed as an option in these cases, however, few studies compared its advantages over open cholecystectomy for elderly patients.


OBJECTIVE
To access the early results of the surgical treatment for cholelithiasis in the elderly submitted to an open or laparoscopic cholecystectomy.


METHODS
retrospective study with 246 patients > 65 years old, who underwent elective cholecystectomy through a subcostal incision (group I) or laparoscopic approach (group II). We employed Student's t test and Spearman's correlation for statistical analysis, considering p < 0,05 as significant.


RESULTS
A hundred and twenty patients were arranged in group I and 126 in group II. Associated diseases were present in 155 cases (63). There were no differences between the groups regarding both the distribution of comorbid conditions. Conversion was evaluated in 10 patients (8.3%). The mean operative time was 133 minutes in group I and 112 minutes in group II (p=0.001). The mean hospital stay in group I was 3,3 days and in group II was 3.2 days p=0.698. Thirteen patients in each group developed complications: group I (10.8%) and group II (10.3%) p=0,896. There was no statistis significance in complication rate related to gender, age, associated diseases and ASA when the both groups were compared. There were two deaths, both in group II, although the mortality rate was not statiscally significant between the groups (p=0.158).


CONCLUSIONS
Both open and laparoscopic cholecystectomy can be practiced in the elderly with low and similar rate of complications.
Régo
Ronaldo Elias Carnut
RE
Departamento de Cirurgia da Faculdade de Ciências Médicas da Santa Casa de São Paulo, SP, Brasil. cir.pancreas@santacasasp.org.br
de Campos
Tércio
T
de Moricz
André
A
Silva
Rodrigo Altenfelder
RA
Pacheco Júnior
Adhemar Monteiro
AM
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy / Q000009:adverse effects / Q000379:methods*; D002769:Cholelithiasis / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D012189:Retrospective Studies; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D020535:Video-Assisted Surgery