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Gallstones in elderly patients: impact of laparoscopic cholecystectomy
A Montori1, M Boscaini, M Gasparrini
1University of Rome "La Sapienza", Rome, Italy. Montori@uniroma1.it
Insights
Laparoscopic cholecystectomy (LC) is safe for elderly patients, even with acute conditions. Gasless LC offers a zero-conversion rate, proving its feasibility and safety in this demographic.
Area of Science:
- Surgical Innovation
- Geriatric Surgery
- Minimally Invasive Procedures
Background:
- Elderly patients undergoing laparoscopic cholecystectomy (LC) face challenges due to poorer cardiopulmonary function.
- Elderly patients more frequently present with acute cholecystitis and common bile duct stones.
- High intraoperative partial pressure of carbon dioxide in blood can necessitate conversion to open cholecystectomy.
Purpose of the Study:
- To evaluate the feasibility and safety of laparoscopic cholecystectomy (LC) in elderly patients.
- To assess the efficacy of gasless LC in reducing conversion rates.
- To analyze outcomes for elderly patients with associated gallbladder and common bile duct stones.
Main Methods:
- Retrospective analysis of 943 laparoscopic cholecystectomies (LCs) performed between 1990 and 1999.
- Focus on 31 LCs performed on elderly patients, including 11 emergency cases.
- Comparison of standard LC with gasless LC in the final three years of the study.
Main Results:
- Ten percent of standard LCs were converted to open procedures, primarily due to elevated CO2 levels.
- Gasless LC in eight elderly patients resulted in a 0% conversion rate.
- Successful management of gallbladder and common bile duct stones in 16% of patients, with 100% success for procedures like endoscopic sphincterotomy.
Conclusions:
- Laparoscopic cholecystectomy (LC) is a safe and feasible surgical option for elderly patients.
- Gasless LC is recommended for patients with American Society of Anesthesiologists' class III, mitigating risks associated with prolonged operative time.
- LC effectively manages complex cases in the elderly, including those with common bile duct stones, with low morbidity and no mortality.
Abstract:
The use of laparoscopic cholecystectomy (LC) in elderly patients may pose problems because of their poor general condition, especially of cardiopulmonary function. Moreover, these patients present with acute cholecystitis and associated common bile duct stones more often than their younger counterparts. From 1990 to 1999, the authors performed 943 LCs; 31 (3.2%) were attempted on elderly patients, 11 (35%) of which were on an emergency basis because of acute cholecystitis, cholangitis or acute biliary pancreatitis. Ten per cent of LCs needed to be converted to an open cholecystectomy, most often because of an increase in the partial pressure of carbon dioxide in the blood produced by excessive operative time. A gasless procedure was used in the last three years of the study on eight cases; the overall rate of conversion from LC to open cholecystectomy in this group was 0%. Associated gallbladder and common bile duct stones were found in five (16%) patients (four preoperative LC endoscopic sphincterotomy and one transcystic approach). The success rate in both of these cases was 100%, overall morbidity was 29% and there was no mortality. These results show that LC is a feasible and safe procedure for use in elderly patients. Gasless LC should be preferred in patients classified as American Society of Anesthesiologists' class III because an excessive duration of operation is the most common reason for converting to an open cholecystectomy.
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