Laparoscopic cholecystectomy for acute cholecystitis in the elderly: a retrospective study

Laparoscopic cholecystectomy for acute cholecystitis in the elderly remains a subject almost unstudied. A first study performed at Brugmann hospital broached the subject, but was rather unsatisfying. In fact, it showed that, except for a shorter hospital stay, laparoscopic cholecystectomy didn't have any advantages over open cholecystectomy. In view of the perfection in surgical technique and of the rapidity of management, we have analyzed our new results and compared them to the ones of our former study.

In this current study we included patients aged over 75 years and with histologically proven acute cholecystitis. As such, we retrospectively studied 20 patients undergoing cholecystectomy from 1997 to 2002. Sixteen patients (80%) underwent laparoscopic cholecystectomy whereas 4 (20%) were considered unable to withstand the laparoscopic approach because of hemodynamic instability, they underwent open cholecystectomy.

Age, APACHE-II scoring, white blood cell counts and CRP were more important in the laparotomy group, but there was no difference in terms of local and general complication or mortality rates between the two groups.

Comparing the results with those of the first study (1991-1997), we established that the laparoscopic approach is very well indicated in the geriatric population. Also, the laparoscopy has been applied more appropriately, seen that our conversion rate dropped to zero. Still, open cholecystectomy proves to be indicated in critically ill patients.