Laparoscopic cholecystectomy in elderly patients.
BACKGROUND
Surgery for cholelithiasis is more common in ageing patients. The use of laparoscopic cholecystectomy (LC) in older patients may pose problems because of the comorbid conditions that are concomitant with advanced age and may increase the postoperative LC complications and the frequency of conversion to open surgery. The purpose of this study was to evaluate the outcome of LC in the treatment of gallstones in the elderly (> or = 75 years old).


METHODS
A retrospective study was conducted in patients who had undergone LC for symptomatic cholelithiasis: out of these, 153 patients were older than 75 years. Conversion rate to open cholecystectomy, complication rate, operative time, and length of stay were compared with those younger than 75 years. Multivariate analysis was used as a control for baseline differences.


RESULTS
Conversion rate to open cholecystectomy in elderly was 13.1% vs 5.8% (p<0.001). Complication rate was 3.9% vs 1.6%. Operative time was 50 min vs 45 min. No significant difference was found in the hospital stay of both younger and elderly patients who had underwent a successful LC (p=0.079). The presence of inflammation was the only independent risk factors for conversion (p=0.014) and had a marginal independent effect on the development of complications (p=0.079) among elderly patients.


CONCLUSIONS
Even though older patients are more likely to present with diseases in more advanced states, LC is safe and should be regarded as the gold-standard approach for elderly patients with cholelithiasis.
2nd Department of Surgery Democritus University of Thrace, Alexandropoulis 68100, Greece. polych@med.duth.gr
Alexandros
A
Polychronidis
Sotirios
S
Botaitis
Alexandra
A
Tsaroucha
Grigoris
G
Tripsianis
Anastasios
A
Bounovas
Michail
M
Pitiakoudis
Constantinos
C
Simopoulos
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D042882:Gallstones / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies