[Laparoscopic surgery in patients over 75 years of age]

Laparoscopic surgery in over-75-year-olds. Surgery in the elderly is becoming increasingly frequent and in some series accounts for around 40% of operations performed. Morbidity and mortality are still high in relation to the type of surgery and anesthesiological risk, with complications linked above all to respiratory and thromboembolic pathologies. The use of a laparoscopic technique in elective and emergency digestive tract surgery may reduce the problems linked to the onset of cardiorespiratory failures and parietal infections. This prospective study aims to evaluate the results of laparoscopic surgery in over-75-year-old patients hospitalised in the Department of Laparoscopic Surgery at Bellvitge Hospital compared to data reported in the literature. Out of 379 patients undergoing laparoscopic surgery, 32 were over-75-year-olds (range 75-89). Ten patients had been diagnosed with gallstones, 9 with acute cholecystitis, 10 with biliary pancreatitis, 2 with iatal hernia and 1 with cancer of the sigma. A total of 29 cholecystectomies were performed, of which 10 in association with pancreatic drainage, 2 Nissen and one left hemicolectomy. Overall mortality was 6.2% following the death of 2 patients: 1 patient, who had been admitted for acute cholecystitis and had undergone laparoscopic cholecystectomy, presented an acute pulmonary edema three days after surgery with cardiac tamponade which represented the cause of death; another patient, admitted for acute biliary pancreatitis, presented a cerebral thromboembolism on the sixth day after surgery leading to death. Other complications included: parietal abscess, basal atelectasis, 2 residual choledochal calculosis and one case of external biliary fistula, with an overall mortality of 9.3%. The results reported in the literature do not report extensive series of over-75-year-olds undergoing laparoscopic surgery. Some authors report high percentages of laparotomic conversion, others a slightly higher morbidity rate with nil mortality. The present results are comparable to those of other authors with regard to the lower morbidity (3.1%) of laparoscopic compared to laparotomic (18.3%) surgery in elderly, high-risk patients. Even if the present series is relatively small (32 patients), the results obtained encourage the use of laparoscopic techniques in over-75-year-old patients so as to reduce mortality and morbidity compared to conventional surgery.