Laparoscopic cholecystectomy in the elderly

Advanced age with its concomitant comorbid conditions may be associated with increased postoperative laparoscsopic cholecystectomy (LC) complications and more frequent conversion to open cholecystectomy (OC). The purpose of this study was to evaluate the outcome of LC in patients age 65 and older.

Ninety consecutive patients were studied age 65 and older, of whom 39 (43%) were males and 51 (57%) were females, mean age 74 years (range 65-98), with 20 patients (22%) >/= 80. Indications for surgery included biliary colic 55 (61%), acute cholecystitis 22 (24%), pancreatitis 10 (11%), and cholangitis 3 (4%). Seventeen patients (19%) had preoperative ERCP, 12 of which were normal; five had sphincterotomy with stone extraction. Comorbid conditions included hypertension (44%), CAD (17%), cardiac arrhythmias (18), CHF (9%), and COPD (7%).

Operative time-mean 1 h 51 min +/- SD 43 min. Conversion to OC-three patients (3%). Length of stay-mean 5 days (range 1-26). Mortality-two patients (2%) >80 years old, one patient with septicemia and multiorgan failure whose comorbid diseases included CAD, C.F., COPPED, and elevated BP, one patient with MI postsurgery, morbid diseases included DM and CAD. Complications-five patients (5%): bile leak from cystic duct stump (one), postsurgery MI (two), incarcerated incisional hernia (one), septicemia (one).

Morbidity rates for LC in the elderly population are not different from that reported for patients less than 65 years of age. (5% vs 6%, Fried et al., Surg Clin North Am 1994;74 [2]: 375-387). Our 2% mortality rate is statistically different from previously reported in a series of patients of all ages (0.6%, Fried et al.). The 3% rate of conversion to OC in this older population is not significantly different from the patients in Fried et al. series (4%).