title: Laparoscopic cholecystectomy in patients aged 60 years and over - our experience.
abstract: Aim.To analyze the efficiency of laparoscopic cholecystectomy for the population aged 60 years and over admitted with acute cholecystitis, the clinical features and associated pathology presented by these patients and the impact of these factors on the choice of surgical technique.Materials and method.A retrospective study was carried out between February 2010 and February 2015, on patients aged 60 years and over, operated in emergency for acute cholecystitis in our clinic. All data were extracted from the registered medical documents and operatory protocols.Results.A total of 497 surgeries were performed for acute cholecystitis, of which 149 were patients aged 60 years and over (30%). Open surgery is much better represented in the population aged over 60 years (61.75% vs. 29.98%). One major cause is the associated pathology that increases the anesthetic risk and hampers a laparoscopic procedure. The conversion rate in the study group presented a higher percentage, but not more exaggerated than in the general population (6.71% vs. 4.63 %).Patients who underwent laparoscopic surgery had a faster recovery and required lower doses and shorter term pain medication, in contrast to conventional surgery (1,8 days vs. 5.7 days). Bile leak has been of reduced quantity, short-term and stopped spontaneously. Only one case needed reintervention, in which aberrant bile ducts that were clipped were found in the gallbladder bed, was operated by laparoscopy. Wound infections and swelling were also encountered more frequently in patients that underwent classic surgery (3.24%).Conclusions.Performing laparoscopic cholecystectomy, when possible, has produced very good results, reducing the average length of stay of patients and even decreasing the number of postoperative complications, thus allowing a faster reintegration of patients into society. The main concern was related to the associated pathology that increased the anesthetic risk.
authors.affiliation: Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
authors.forename: D
authors.initials: D
authors.lastname: Serban
authors.affiliation: Upper Digestive Surgery Clinic, Emergency University Hospital, Bucharest, Romania.
authors.forename: C
authors.initials: C
authors.lastname: Branescu
authors.affiliation: Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
authors.forename: C
authors.initials: C
authors.lastname: Savlovschi
authors.affiliation: Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
authors.forename: A P
authors.initials: AP
authors.lastname: Purcărea
authors.affiliation: Upper Digestive Surgery Clinic, Emergency University Hospital, Bucharest, Romania.
authors.forename: A
authors.initials: A
authors.lastname: El-Khatib
authors.affiliation: Upper Digestive Surgery Clinic, Emergency University Hospital, Bucharest, Romania.
authors.forename: S A
authors.initials: SA
authors.lastname: Balasescu
authors.affiliation: Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
authors.forename: A
authors.initials: A
authors.lastname: Nica
authors.affiliation: Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
authors.forename: A M
authors.initials: AM
authors.lastname: Dascalu
authors.affiliation: Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
authors.forename: G
authors.initials: G
authors.lastname: Vancea
authors.affiliation: Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
authors.forename: S M
authors.initials: SM
authors.lastname: Oprescu
authors.affiliation: Upper Digestive Surgery Clinic, Emergency University Hospital, Bucharest, Romania.
authors.forename: C
authors.initials: C
authors.lastname: Tudor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000379:methods*; D041881:Cholecystitis, Acute / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008099:Liver / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012744:Sex Ratio; D016896:Treatment Outcome; D055815:Young Adult
keywords: acute cholecystitis; cholecystectomy; elderly; laparoscopy