title: Predictive factors of difficult procedure in octogenarians undergoing elective laparoscopic cholecystectomy: a single center experience.
abstract: OBJECTIVE
  To assess the feasibility and safety of laparoscopic cholecystectomy (LC) in very elderly patients with particular attention to the predicitive factors of difficulty.
  
  
  METHODS
  All patients aged ≥ 80 undergoing elective LC for lithiasis at our institution since 1st January 2015 to 31st December 2015 were included in the study. Exclusion criteria were: a) acute cholecystitis; b) biliary pancreatitis; c) biliary tract neoplasms; d) urgent procedure. Pre-, intra- and postoperative data were recorded.
  
  
  RESULTS
  During the study period, we performed 72 LC and we enrolled 17 patients aged ≥ 80 with a M:F = 5:12. Of these, 10 patients had a "difficult" cholecystectomy. In seven cases an intraoperative cholangiography (IOC) was performed. Postoperative course was regular but in two patients we had an Oddian spasm in 1st postoperative day. Female sex (p=0.03) and preoperative high level of serum amylase (p= 0.02) were significantly associated to difficult cholecystectomy in elderly patients.
  
  
  CONCLUSIONS
  LC in octogenarians is feasible and safe. However, sex and serum amylase can help the surgeon to predict a more difficult procedure in elective LC. In this group of patients an approach based on the individual risk is desirable and the patient could be referred to a multidisciplinary approach.
authors.forename: F
authors.initials: F
authors.lastname: Guida
authors.forename: L
authors.initials: L
authors.lastname: Monaco
authors.forename: M
authors.initials: M
authors.lastname: Schettino
authors.forename: R
authors.initials: R
authors.lastname: Porfidia
authors.forename: G
authors.initials: G
authors.lastname: Iapicca
mesh_terms: D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic / Q000379:methods; D041881:Cholecystitis, Acute / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome