J Korean Surg Soc.  2009 Apr;76(4):231-235. 10.4174/jkss.2009.76.4.231.

Is Laparoscopic Cholecystectomy Safe in Octogenarians?

• Cho JY
• Kim JY
• Chang SK
• Kim SG
• Hwang YJ
• Yun YK

• KMID: 1465061
• DOI: http://doi.org/10.4174/jkss.2009.76.4.231

Abstract

PURPOSE: Biliary tract disease is one of the most common causes of acute abdominal pain in elderly patients, but there is still some debate over treatment. The aim of this study is to determine the safety and surgical outcomes of laparoscopic cholecystectomy (LC) for benign gallbladder disease in octogenarian patients.
METHODS
We selected 42 patients of 80 years or older who underwent LC or open-converted cholecystectomy (OC) from February 1992 to November 2006. We evaluated clinicopathological features, treatment modalities, and surgical outcomes retrospectively.
RESULTS
The patients included 17 males and 25 females. The mean age of the patients was 83.3 and 83.7, respectively. Right upper quadrant pain was the most common symptom, present in 85.7% of the patients. Gallstones were present in 85.7%. ASA class II and III comprised 92.9% of the patients. Comorbidities included hypertension, cardiac disease, pulmonary disease, and diabetes mellitus. Preoperatively biliary drainage was performed in 12 cases (endoscopic drainage in 8, percutaneous drainage in 4 cases). Preoperative cholecystostomy was performed in 5 cases. Emergency operations were more frequent than elective surgery (25 vs. 17). Mean hospital stay of LC patients was 5 days, whereas that of OC patients was 13 days. Open conversion rate was 16.7%. No surgical mortality was present and postoperative morbidity included acute myocardial infarction in one patient and wound infection in one patient.
CONCLUSION
LC in octogenarian patients was safe. However, since the incidence of comorbidities is high in these patients, great care should be taken to evaluate and manage the comorbidities before surgery.

Keyword

Laparoscopic cholecystectomy; Octogenarian

MeSH Terms

Abdominal Pain
Aged
Aged, 80 and over
Biliary Tract Diseases
Cholecystectomy
Cholecystectomy, Laparoscopic
Cholecystostomy
Comorbidity
Diabetes Mellitus
Drainage
Emergencies
Female
Gallbladder Diseases
Gallstones
Heart Diseases
Humans
Hypertension
Incidence
Length of Stay
Lung Diseases
Male
Myocardial Infarction
Wound Infection

Figure

• 

  Fig. 1 The difference of mean age, frequency of octogenarian, percentage of female in the patients who underwent laparoscopic cholecystectomy according to periods in Kyungpook National University Hospital (n=2,554). In 57 cases, operative date was not available. *Data are given as mean±SD.

Reference

1. Mouret P. From the first laparoscopic cholecystectomy to the frontiers of laparoscopic surgery: the future prospectives. Dig Surg. 1991. 8:124–125.

2. Cha SW, Chun GJ, Park YS, Song DH, Cho YD, Kim JO, et al. Clinical features of gallstone in elderly patients. Korean J Gastroenterol. 1996. 28:260–266.

3. Harness JK, Strodel WE, Talsma SE. Symptomatic biliary tract disease in the elderly patient. Am Surg. 1986. 52:442–445.

4. Ross SO, Forsmark CE. Pancreatic and biliary disorders in the elderly. Gastroenterol Clin North Am. 2001. 30:531–545.

5. Walsh RM. Innovations in treating the elderly who have biliary and pancreatic disease. Clin Geriatr Med. 2006. 22:545–558.

6. Brunt LM, Quasebarth MA, Dunnegan DL, Soper NJ. Outcomes analysis of laparoscopic cholecystectomy in the extremely elderly. Surg Endosc. 2001. 15:700–705.

7. Johansson M, Thune A, Nelvin L, Stiernstam M, Westman B, Lundell L. Randomized clinical trial of open versus laparoscopic cholecystectomy in the treatment of acute cholecystitis. Br J Surg. 2005. 92:44–49.

8. Lujan JA, Sanchez-Bueno F, Parrilla P, Robles R, Torralba JA, Gonzalez-Costea R. Laparoscopic vs. open cholecystectomy in patients aged 65 and older. Surg Laparosc Endosc. 1998. 8:208–210.

9. Vagenas K, Karamanakos SN, Spyropoulos C, Panagiotopoulos S, Karanikolas M, Stavropoulos M. Laparoscopic cholecystectomy: a report from a single center. World J Gastroenterol. 2006. 12:3887–3890.

10. Burdiles P, Csendes A, Diaz JC, Maluenda F, Avila S, Jorquera P, et al. Factors affecting mortality in patients over 70 years of age submitted to surgery for gallbladder or common bile duct stones. Hepatogastroenterology. 1989. 36:136–139.

11. Irvin TT, Arnstein PM. Management of symptomatic gallstones in the elderly. Br J Surg. 1988. 75:1163–1165.

12. Majeski J. Laparoscopic cholecystectomy in geriatric patients. Am J Surg. 2004. 187:747–750.

13. Bakkaloglu H, Yanar H, Guloglu R, Taviloglu K, Tunca F, Aksoy M, et al. Ultrasound guided percutaneous cholecystostomy in high-risk patients for surgical intervention. World J Gastroenterol. 2006. 12:7179–7182.

14. Patel M, Miedema BW, James MA, Marshall JB. Percutaneous cholecystostomy is an effective treatment for high-risk patients with acute cholecystitis. Am Surg. 2000. 66:33–37.

15. Krasman ML, Gracie WA, Strasius SR. Biliary tract disease in the aged. Clin Geriatr Med. 1991. 7:347–370.

16. Fried GM, Clas D, Meakins JL. Minimally invasive surgery in the elderly patient. Surg Clin North Am. 1994. 74:375–387.

17. Kwon AH, Inui H. Preoperative diagnosis and efficacy of laparoscopic procedures in the treatment of Mirizzi syndrome. J Am Coll Surg. 2007. 204:409–415.

18. Eldar S, Sabo E, Nash E, Abrahamson J, Matter I. Laparoscopic cholecystectomy for acute cholecystitis: prospective trial. World J Surg. 1997. 21:540–545.

19. Maxwell JG, Tyler BA, Maxwell BG, Brinker CC, Covington DL. Laparoscopic cholecystectomy in octogenarians. Am Surg. 1998. 64:826–831.