Clinical Analysis of Gasless Single-Channel Laparoscopic Cholecystectomy for Elderly Patients With...

The retrospective comparative cohort study aimed to determine whether gasless single-channel laparoscopic cholecystectomy (GSLC) was associated with lower early postoperative stress and inflammatory responses than conventional carbon dioxide pneumoperitoneum laparoscopic cholecystectomy (LC) in older patients. Eighty geriatric patients (60 years old and older) were selected and compared (LC, n = 40; GSLC, n = 40). Stress biomarkers (norepinephrine, cortisol, and blood glucose) and inflammatory biomarkers (procalcitonin, C-reactive protein, and tumor necrosis factor-alpha) were evaluated before surgery and at 24 and 72 hours after surgery, as well as during the operative time, and related to estimated blood loss, postoperative complications, and length of stay. All in all, GSLC showed a steady reduction in postoperative increase in stress and inflammatory markers over time compared to LC, indicating a less intense physiologic perturbation during the initial phase of recovery. Results of the operation were more favorable to GSLC, with reduced operative time and less blood loss, and the postoperative endpoints showed fewer early complications and a shorter stay. These results indicate that gasless single-channel methods can be potentially helpful in physiologically vulnerable patients in the elderly, as they diminish the early postoperative stress and inflammatory processes; nevertheless, due to the retrospective study, standardized method of technique, and extended period of follow-up, prospective randomized trials are needed to confirm these relationships and to formulate clinical practice recommendations.