Laparoscopic Cholecystectomy: Treatment o Choice in Elderly Patients

Abstract

Abstract: The application of laparoscopic] cholecystectomy, first reported in 1987, has grown rapidly worldwide, replacing the open cholecystectomy. This trend is attributable to the benefits of minimal surgical access, i. e. a smaller incision, less postoperative pain and faster recovery. However, doubts persist concerning the role of laparoscopic cholecystectomy in elderly patients. The purpose of this study was to assess morbidity and mortality in elderly patients who underwent laparoscopic cholecystectomy at Teikyo University Hospital at Mizonokuchi. Forty‐eight patients, 65 years or older, underwent attempted or successful laparoscopic cholecystectomy. To assess operative risk in these patients, the American Society of Anesthesiologist's Surgical Risk (A. S. A.) category was used. The risk ranged from 1 to 3 with a median of 2. Twenty‐five percent of the patients were defined as A. S. A. I, 61% as A. S. A. II and 14% as A. S. A. III. Four patients required intraoperative conversion of the procedure to open cholecystectomy (conversion rate of 8.3%). The indications for conversion in three patients were severe adhesion and thickened gallbladder wall and in the other were secondary to gallbladder bed oozing. This conversion rate is similar to that reported in other series. The conversion was not related to the surgical risk. The morbidity rate was 4.5%. the mortality rate zero. These results compared favorably with those reported for open cholecystectomy in elderly patients and with the overall published morbidity‐mortality rate of laparoscopic cholecystectomy in large series. We conclude that laparoscopic cholecystectomy is a suitable procedure for elderly patients.