title: Role of fundus-first laparoscopic cholecystectomy in the management of acute cholecystitis in elderly patients.
abstract: BACKGROUND
  Conversion from laparoscopic cholecystectomy to open cholecystectomy leads to the loss of the advantages of this minimally invasive procedure and significantly increases length of hospital stay as well as cost. The conversion from laparoscopic to open cholecystectomy is more frequent among patients with acute cholecystitis and in elderly patients. This study evaluated whether fundus-first laparoscopic cholecystectomy could lower the conversion rate in geriatric patients with acute cholecystitis.
  
  
  METHODS
  During a twelve-month period, 112 patients (36 of them age 65 years or older) underwent fundus-first laparoscopic cholecystectomy for acute cholecystitis in a tertiary care university hospital in central Taiwan.
  
  
  RESULTS
  The conversion rate in the elderly patients was 2.7% (1/36). No major perioperative complications were observed. Minor complications--port-site infection and subhepatic fluid collection-occurred in two patients (5.5%).
  
  
  CONCLUSIONS
  Laparoscopic cholecystectomy with a fundus-first approach is a safe, effective operative procedure for elderly patients with acute cholecystitis when performed by an experienced laparoendoscopic surgeon.
authors.affiliation: Trauma & Emergency Center, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Yu-Chun
authors.initials: YC
authors.lastname: Wang
authors.forename: Horng-Ren
authors.initials: HR
authors.lastname: Yang
authors.forename: Ping-Kuei
authors.initials: PK
authors.lastname: Chung
authors.forename: Long-Bin
authors.initials: LB
authors.lastname: Jeng
authors.forename: Ray-Jade
authors.initials: RJ
authors.lastname: Chen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D041881:Cholecystitis, Acute / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D016896:Treatment Outcome