Page 20 - World Journal of Laparoscopic Surgery

Laparoscopic Cholecystectomy in Patients Over 80 Years is Feasible and Safe: Analysis of 68 Consecutive Cases

of the cases started by a specialist registrar had to be completed 2. Bufalari A, Ferri M, Cao P, Cirocchi R, Bisacci R, et al. Surgical
by a consultant, underlining the need for senior surgical care in octogenarians. Br J Surg, Dec 1996;83(12):1783-87.
involvement in these cases. 3. Kwon AH, Matsui Y. Laparoscopic cholecystectomy in patients
The complication rate (24%) was comparable to rates of 2.2- aged 80 years and over. World J Surg, Jul 2006;30(7):1204-10.
26% from previous studies of laparoscopic cholecystectomy in 4. Lujan JA, Sanchez-Bueno F, Parrilla P, Robles R, Torralba JA,
octogenarians. 3,5-7 The grade 2 complications were all directly et al. Laparoscopic vs. open cholecystectomy in patients aged
related to cholecystectomy. The most striking feature of these 65 and older. Surg Laparosc Endosc, Jun 1998;8(3):208-10.
cases was the statistically significant incidence of CBD stones 5. Hazzan D, Geron N, Golijanin D, Reissman P, Shiloni E.
(p = 0.0003). Whilst the bile duct injuries and bile leak can be Laparoscopic cholecystectomy in octogenarians. Surg Endosc,
directly related to the presence of CBD stones, this was not an May 2003;17(5):773-76.
exclusive factor. Three patients in our series underwent 6. Brunt LM, Quasebarth MA, Dunnegan DL, Soper NJ. Outcomes
analysis of laparoscopic cholecystectomy in the extremely
laparoscopic bile duct exploration, one of which was complicated elderly. Surg Endosc, Jul 2001;15(7):700-05.
by a hepatic duct injury. The debate concerning ERCP or 7. Maxwell JG, Tyler BA, Rutledge R, Brinker CC, Maxwell BG,
laparoscopic bile duct exploration has favored laparoscopic Covington DL. Cholecystectomy in patients aged 80 and older.
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exploration, dependent upon local expertise and availability. Am J Surg, Dec 1998;176(6):627-31.
Little of the existing data comes from octogenarians and this 8. Tang B, Cuschieri A. Conversions during laparoscopic
series suggests that the risks of an operative approach are cholecystectomy: Risk factors and effects on patient outcome. J
higher. Gastrointest Surg, Jul-Aug 2006;10(7):1081-91.
9. Pessaux P, Tuech JJ, Derouet N, Rouge C, Regenet N, et al.
CONCLUSION Laparoscopic cholecystectomy in the elderly: A prospective
study. Surg Endosc, Nov 2000;14(11):1067-69.
Patients over 80 years should be considered for laparoscopic 10. Uecker J, Adams M, Skipper K, Dunn E. Cholecystitis in the
cholecystectomy for symptomatic gallstones. Although the octogenarian: Is laparoscopic cholecystectomy the best
overall risk of complications remains higher in these patients, approach? Am Surg, Jul 2001;67(7):637-40.
conversion rates can be low. Patients over 80 years with common 11. Fried GM, Clas D, Meakins JL. Minimally invasive surgery in
bile duct stones may be best managed with ERCP as this group the elderly patient. Surg Clin North Am, Apr 1994;74(2):375-
of patients appears to be at particular risk from surgical 87.
intervention. 12. Magnuson TH, Ratner LE, Zenilman ME, Bender JS.
Laparoscopic cholecystectomy: applicability in the geriatric
ACKNOWLEDGMENTS population. Am Surg, Jan 1997;63(1):91-96.
13. Clavien PA, Sanabria JR, Strasberg SM. Proposed classification
David Rayment for data lists and notes retrieval.
of complications of surgery with examples of utility in
cholecystectomy. Surgery, May 1992;111(5):518-26.
REFERENCES 14. Nathanson LK, Shaw IM. Gallstones. In: James Garden O, editor.
1. National Institutes of Health Consensus Development A companion to specialist surgical practice – hepatobiliary and
Conference Statement on Gallstones and Laparoscopic pancreatic surgery. Philadelphia: Elsevier Saunders 2005;3:167-
Cholecystectomy. Am J Surg, Apr 1993;165(4):390-98. 92.

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