title: Considerations concerning laparoscopic cholecystectomy in the extremely elderly.
abstract: BACKGROUND
  Since octogenarians become a growing part of the population and surgical care is possible in them, this study was conducted to evaluate the outcome of laparoscopic cholecystectomy in patients 80 years of age and over.
  
  
  METHODS
  From June 1993 to May 2006, a total of 1263 patients underwent a laparoscopic cholecystectomy, applying the four-trocar American technique; 21 among them were >/=80 years. We retrospectively reviewed patients' age, gender, indication for surgery, comorbid conditions, American Society of Anesthesiologists (ASA) score, conversion to open procedure, postoperative complications, and length of hospital stay.
  
  
  RESULTS
  The mean age in the >/=80 group was 82.5+/-3 and 57% were women, while in the <80 group 72% of patients were women. Recurrent biliary colic was the most frequent (62%) indication for surgery among the elderly patients. Endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy were performed preoperatively in 6 elderly patients (29%); there were 4 cases of acute calculus pancreatitis and 2 cases of acute cholangitis. A high surgical risk (ASA score of III and IV) was estimated in 11 patients (52%) from the >/=80 group versus 32% in the <80 group (P =0.047). Conversion rate was higher (19%) and hospital stay was longer (4.9 days) in the >/=80 group, compared to younger patients (P =0.01). Mortality was zero and morbidity was 14% versus 3% in the <80 group (P =0.03), including 1 case of postoperative bleeding, 1 case of wound infection, and 1 case of pulmonary atelectasis, respectively.
  
  
  CONCLUSIONS
  Laparoscopic cholecystectomy in the extremely elderly is safe and well tolerated; however, it is associated with a higher conversion rate, increased morbidity, and a longer hospital stay.
authors.affiliation: 2nd Propedeutical Department of Surgery, Medical School, Aristotle University, Hippocration Hospital, Thessaloniki, Greece. pavlidth@med.auth.gr
authors.forename: Theodoros E
authors.initials: TE
authors.lastname: Pavlidis
authors.forename: Georgios N
authors.initials: GN
authors.lastname: Marakis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Symeonidis
authors.forename: Kyriakos
authors.initials: K
authors.lastname: Psarras
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Ballas
authors.forename: Savvas
authors.initials: S
authors.lastname: Rafailidis
authors.forename: Athanasios K
authors.initials: AK
authors.lastname: Sakantamis
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D001660:Biliary Tract Diseases / Q000601:surgery; D002761:Cholangitis / Q000150:complications; D017081:Cholecystectomy, Laparoscopic / Q000379:methods; D003085:Colic / Q000601:surgery; D015897:Comorbidity; D005260:Female; D042882:Gallstones / Q000601:surgery; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000150:complications; D011183:Postoperative Complications; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome