Laparoscopic Cholecystectomy in Elderly Patients

Lim, Man Sup; Joo, Sun Hyung; Lee, Samuel; Park, Chan Heun; Kim, Joo Seop

Abstract

PURPOSE
Open cholecystectomy is preferred to a laparoscopic approach in elderly patients with gallstones, because acute inflammation is more frequent in this age group than in younger patients. However, the surgical morbidity and mortality of an open cholecystectomy are known to be higher than for a laparoscopic cholecystectomy. The aim of this study was to analyze the outcome of laparoscopic cholecystectomy in elderly patients, and to assess its safety and feasibility. METHODS: 289 laparoscopic cholecystectomy cases were enrolled with regard to their clinical parameters. There were 49 patients older and 240 younger than 70 years of age; Groups A and B, respectively. RESULTS: There were no demographic differences between the two groups. The preoperative presentation of acute cholecystitis was higher in Group A (53.1 versus 37.1%, p< 0.05). The average times interval from the initial symptoms to the operation were 36.3 and 50.2 days in Groups A and B, respectively. The rate of combined choledocholithiasis was higher in Group A (20.4 versus 9.2%, p< 0.05). The average operation time was similar in both groups (83.7+/-29.5 versus 83.0+/-29.3minute). The conversion rate from a laparoscopic to an open cholecystectomy was higher in group A (8.2% versus 2.9%, p=0.08). There were no differences in hospital stays and postoperative complications between the two groups. CONCLUSION: From this study, a laparoscopic cholecystectomy is suggested as a safe and effective treatment in elderly patients. Therefore, a laparoscopic cholecystectomy should be initially and actively performed, rather than an open cholecystectomy in elderly patients.