Page 17 - World Journal of Laparoscopic Surgery

World Journal of Laparoscopic Surgery, May-August 2009;2(2):22-25
R Dennis et al

Laparoscopic Cholecystectomy in Patients Over

80 Years is Feasible and Safe: Analysis of 68

Consecutive Cases

R Dennis, R Guy, F Bajwa
Department of General Surgery, Peterborough District Hospital, Thorpe Road , Peterborough PE3 6DA, United Kingdom
Correspondence: R Dennis, Department of General Surgery, Heath Road, Ipswich, Suffolk IP4 5PD, United Kingdom
Phone: +441473 712233, Fax: +441473 703400, E-mail: robertdennis@nhs.net

Abstract the population over 80 years old undergoing laparoscopic
Background: Wide variations are reported in morbidity, mortality and cholecystectomy may have morbidity rates of 2.2-24% and
conversion rates for laparoscopic cholecystectomy in the mortality rates of up to 2.8%. 3-7
octogenarian population. As a retrospective review, this paper reports The potential benefits of laparoscopic surgery may be lost
the experience of a district general hospital unit in the management of if conversion to an open operation is necessary. If not unduly
gallstone disease in an elderly population. delayed, conversion carries similar risks to open chole-
Methods: The case notes of all patients over 80 years of age undergoing cystectomy, whereas ‘enforced’ conversion usually following
laparoscopic cholecystectomy over a 7 years period were severe iatrogenic injury or bleeding is associated with higher
retrospectively analyzed. Primary outcome measures were conversion morbidity and mortality. Patients over 80 years generally have
8
to an open procedure and complications of surgery.
higher conversion rates of 2.2-37%, 3-5,9-11 the most significant
Results: Sixty-eight octogenarians (mean age of 84 years [range 80- factor being the increased incidence of complex pathologies
96 years], 37 female) undergoing laparoscopic cholecystectomy were related to gallstones. The incidences of acute and chronic
identified. Five (7.3%) operations were converted to open surgery.
cholecystitis, severe scarring and adhesions, common bile duct
The total number of patients having complications was 16 (24%), stones, gallstone pancreatitis, previous upper abdominal
8 (12%) being grade 1 and 8 (12%) grade 2. Forty-eight (71%) patients
had complicated gallstone disease. Grade 2 complications were related surgery and gallbladder cancers are all increased in the elderly
5,6,12
to the presence of CBD stones (p = 0.0003). population.
This paper reports the experience of a district general hospital
Conclusion: Octogenarians should be considered for laparoscopic
cholecystectomy for symptomatic gallstones. Although the overall unit in the management of gallstone disease in a population
risk of complications remains higher in octogenarians, conversion over 80 years old.
rates can be low. Octogenarians with common bile duct stones may
be best managed with ERCP as this group of patients appears to be at MATERIAL AND METHODS
particular risk from surgical intervention.
The records of all patients over the age of 80 years undergoing
Keywords: Octogenarian, cholecystectomy, conversion
laparoscopic cholecystectomy between January 2000 and June
2007 were retrospectively analyzed. Age, sex and American
INTRODUCTION
Society of Anesthesiologists (ASA) grade and indications for
Improvements in perioperative care for the ageing population surgery were recorded. The method of evaluation of bile duct
have resulted in an increasing number of elderly patients being stones was noted on preoperative ultrasound, MRCP or ERCP,
considered for surgery. With an incidence of gallstone disease or intraoperative cholangiography. The difficulty of surgical
1
of 14-27%, it is inevitable that significant numbers of elderly dissection of the gallbladder and Calot’s triangle was assessed
symptomatic patients are referred for surgery despite historical from the operating notes. ‘Difficult’ dissections were considered
concerns over comorbid conditions and more complex gallstone as those where the operation note commented on dense
disease. adhesions of colon, duodenum or omentum, a thick walled
Increased risks and complications of surgery in the elderly 2 gallbladder, empyema of the gallbladder or a shrunken fibrotic
may be reduced by minimally invasive surgery which is gallbladder. The mode of surgery was classified as either elective
associated with a shorter hospital stay and fewer complications or emergency. For elective cases the patient with no acute
3
in elderly patients. However, even with laparoscopic surgery symptoms had a planned admission either on the day of surgery
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