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Laparoscopic Cholecystectomy is Safe in the Elderly Patients
DISCUSSION Laparoscopic Cholecystectomy for Elderly Patients with Acute
Cholecystitis: Arch Surg 2000;135:457-62.
Laparoscopic cholecystectomy has gained a lot of attention 2. Dhoste K, Lacoste L, Karayan J, Lehuede MS, Thomas D,

around the world. However, the role of (LC) in elderly, remain Fusciardi J. Haemodynamic and ventilatory changes during

controversial. laparoscopic cholecystectomy in elderly ASA III patients:
Several controlled trials have been conducted, some are in Canadian Journal of Anesthesia/Journal canadien d’anesthésie:
favour of laparoscopy, others not .The goal of this review was Volume 43, Number 8/August, 1996.

to as certain that if the (LC) in elderly is safe and superior to the 3. Shih-Ping Cheng, Yuan-Ching Chang, Chien-Liang Liu, Tsen-

conventional, and if so what are the benefit and how it could it Long Yang, Kuo-Shyang Jeng, Jie-Jen Lee and Tsang-Pai Liu:
be instituted more widely. Factors associated with prolonged stay after laparoscopic chole-
Emergency surgery on older patients with gallstones may cystectomy in elderly patients: Surgical Endoscopy Volume 22,
have fatal outcome due to increased co morbidities and decreased Number 5/May, 2008.
functional reserve. Thus, elective surgery with acceptable 4. Juliane Bingener, Melanie L Richards, Wayne H Schwesinger,
William E Strodel, Kenneth R Sirinek. Laparoscopic Cholecys-
morbidity and mortality should be the preferred choice over tectomy for Elderly Patients Gold Standard for Golden Years?
emergency procedures. 16 Arch Surg 2003;138:531-36.
LC in elderly patients suffering from acute cholecystitis is 5. Sánchez BJ, Gil-Albarellos PS, Moreno MN, Monsalve LE,
feasible and effective. It is associated with a higher rate of García SCE. Indications, morbidity and results of laparoscopic
morbidity unrelated to the surgical site and mortality in elderly treatment of cholelithiasis in the elderly people: Rev Mex Cir
compared with younger patients. Stronger selection of elderly Endoscop 2007;8(2):79-84.
patients for surgery is needed. 3,16 6. Kirshtein B, Bayme M, Bolotin A, Mizrahi S, Lantsberg L.
Increased technical experience with LC favorably affected Laparoscopic Cholecystectomy for Acute Cholecystitis in the
outcomes over time. Early diagnosis and treatment prior to onset Elderly: Is it Safe? Surgical Laparoscopy, Endoscopy and
of complications are necessary for further improvement in the Percutaneous Techniques 2008; 18(4):334-39.
outcomes of elderly patients undergoing LC. 4,6 7. Macrý A, Scuderi G, Saladino E, Trimarchi G, Terranova
Cardiovascular stability in elderly ASA III patients can be M,Versaci A,C. Famulari : Acute gallstone cholecystitis in the
maintained by gradual abdominal insufflations to 12 mm Hg elderly. Treatment with emergency ultrasonographic percu-
taneous cholecystostomy and interval laparoscopic cholecy-
followed by 10° head up tilt. stectomy: Surgical Endoscopy, Volume 20, Number 1/January
For LC for patients with an ASA 3 and 4 risk for anesthesia, 2006.
no significant adverse effects could be attributed to CO 2 8. Alfred Cuschieri. How I do it, Laparoscopic cholecystectomy:
pneumoperitoneum. 10,12,13 For high-risk patients, preoperative JR Coll Surg Edinb 44, June 1999;187-92.
preparation and active perioperative monitoring are essential 9. Yoshito Nagashima, Song H, Kim I, Tetsutaro Otagiri.
for safe anesthesia for LC with or without CO PP. 13 Anesthesia for laparoscopic cholecystectomy in an elderly
2
For safe LC in this high-risk population and to reduce patient with emphysematous bullaemcombined general and
regional variation, Efforts should be focused on disseminating epidural anesthesia with spontaneous respiration and abdominal
techniques. wall-left method: Journal of Anesthesia,Volume 9, Number
4/December 1995.
10. A Hon Kwon, Yoichi Matsui. Laparoscopic Cholecystectomy
CONCLUSION
in Patients Aged 80 Years and Over: World Journal of Surgery,
Even elderly patients are more likely to present with disease in Volume 30, Number 7/July, 2006.
more advanced state, LC is safe and should be regarded gold 11. Annamaneni RK, Moraitis D, Cayten CG. Laparoscopic Chole-
stander for elderly patients with cholelithiasis. cystectomy in the Elderly: Journal of the American Geriatrics
Early elective LC should be encouraged. Emergency surgery Society, May 2008;56(5):962-63.
in elderly group carries more morbidity than younger age group. 12. Pessaux P, Tuech JJ, Derouet N, Rouge C, Regenet N, Arnaud
For high-risk patients, good preoperative preparation and JP. Laparoscopic cholecystectomy in the elderly. A prospective
study: Surgical Endoscopy, Volume 14, Number 11/ November,
perioperative monitoring are essential for safe anesthesia. 2000.
Surgeons need to inform primary care physicians of the 13. AM Koiv usalo, Pere P, Valjus M, Scheinin T. Laparoscopic
excellent result of laparoscopic procedures in the elderly to cholecystectomy with carbon dioxide pneumoperitoneum is
encourage earlier referrals. safe even for high-risk patients:Surg Endoscopy, 22/(1), Jan/
2008.
REFERENCES 14. Andrew L Tambyraja, Sudhir Kumar, Stephen J Nixon. Outcome
of Laparoscopic Cholecystectomy in Patients 80 Years and
1. William S Laycock, Andrea E Siewers. Christian M Birkmeyer, Older: ANZ Journal of Surgery Published Online: 22 Jun
David E Wennberg, John D Birkmeyer. Variation in the use of 2005;75(7):550-52.
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