Page 7 - World Journal of Laparoscopic Surgery

ORIGINAL ARTICLE
Laparoscopic Cholecystectomy: Challenges and Outcomes of

the Procedure in Elderly Patients

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Sarbjeet Singh , Amandeep Singh , Ashwani Kumar , Rohit Kapoor , Sumit Mahajan 5
AbstrAct
Introduction: Gallstone disease is more prevalent in the elderly population besides having comorbid conditions and poor physiological reserves
as compared with their younger counterpart. Laparoscopic procedures have certain inherent technical limitations and unique physiological
demands. Hence, the procedures may have higher complications in elderly patients and need evaluation in this age-group of patients.
Aim: This study is aimed to evaluate the safety of the procedure of laparoscopic cholecystectomy in elderly patients in terms of preoperative
and intraoperative difficulties, postoperative complications, morbidity, and mortality.
Materials and methods: The study was conducted retrospectively, collecting data from hospital record of a total of 390 patients (45 elderly
patients) operated during a period from 2012 to 2017.
Results: The mean age of elderly patients was 66.7 years. All the patients who underwent laparoscopic cholecystectomy had an American
Society of Anesthesiologist (ASA) score of I or II. Intraoperative difficulties were encountered in 35.55% patients. Average hospital stay was 2.5
days. One patient had a minor bile leak. No mortality occurred.
Conclusion: Procedure of laparoscopic cholecystectomy is safe in elderly patients.
Keywords: Elderly patients, Laparoscopic cholecystectomy, Procedural challenges.
World Journal of Laparoscopic Surgery (2019): 10.5005/jp-journals-10033-1383

IntroductIon 1–5 Department of Surgery, Guru Gobind Singh Medical College and
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Prevalence of gallstone disease increases with age. Further, Hospital, Faridkot, Punjab, India
symptoms and complications of gallstones increase with age, Corresponding Author: Amandeep Singh, Department of Surgery,
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leading to more frequent cholecystectomies. As laparoscopic Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab,
procedures have inherent technical limitations compared to India, Phone: +91 9876201644, e-mail: singhdramandeep80@gmail.
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open surgical procedures, the procedure of laparoscopic com
cholecystectomy may have higher rate of complications in elderly How to cite this article: Singh S, Singh A, Kumar A, et al. Laparoscopic
patients due to the frequent comorbid conditions and poor Cholecystectomy: Challenges and Outcomes of the Procedure in
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functional reserves. Hence, elderly patients may be considered as Elderly Patients. World J Lap Surg 2019;12(3):93–95.
a separate group of patients for laparoscopic cholecystectomy. The Source of support: Nil

present study is aimed to evaluate the procedure for its outcome Conflict of interest: None
and challenges in elderly patients.
AIm other studies. All these patients were operated under general

The aim of the study is to evaluate the safety of laparoscopic anesthesia and surgeries were performed by trained surgeons.
cholecystectomy in elderly patients in terms of preoperative and Procedures were performed by four port techniques, using 10 mm,
intraoperative difficulties, postoperative complications, morbidity, 30° telescope, and using titanium clips to ligate cystic duct and
and mortality. cystic artery. Gallbladder was dissected from fossa using monopolar
electrocautery and extracted through 10 mm epigastric port.

mAterIAls And methods Postoperatively all the patients were managed in general wards
and broad-spectrum antibiotics were used for 5–7 days.
This study was conducted retrospectively, in the Department of
General Surgery, at GGS Medical College, Faridkot, Punjab. We results And dIscussIon

searched the hospital record of 390 patients who underwent
laparoscopic cholecystectomy during a period from 2012 to 2017. Frequency of gallstones increases after the age of 40 to become
Of these 390 patients, 45 patients were found to be in elderly age- 4–10 times more in older individuals and laparoscopy is gradually
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group, i.e., >60 years (according to the World Health Organization replacing common surgical procedures. Our study comprises
definition for developing countries). Preoperative, intraoperative, 45 elderly patients among a total of 390 patients who underwent
and postoperative records of these patients were analyzed in laparoscopic cholecystectomy, during the mentioned period. In
terms of the ASA score, comorbid conditions, intraoperative this study, the mean age of elderly patients was 66.7 years (range
bleeding, adhesions, difficulties of dissection, injury to organs 61–76 years), and majority of the patients was female, with a male
and bile duct, operative time, conversion rate, hospital stay, and to female ratio of 1:2.75. When stratified for age, we observed that
postoperative complications. The results were compared with 82.22% patients was in 60–70 years age-group, whereas 17.77%
© The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.
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