Cholecystectomy In Elderly Patients Research Articles

Outcomes of Laparoscopic Cholecystectomy in Elderly Patients

Background: Laparoscopic cholecystectomy (LC) is the standard treatment for both symptomatic gallstones and acute cholecystitis. Laparoscopic cholecystectomy is the surgical procedure to remove the gallbladder. While historically challenging in cases of acute cholecystitis, advancements in laparoscopic techniques have made it a viable and preferred treatment option for this condition. Objective: Our study’s objective was to evaluate the efficacy of LC in elderly individuals. Methods: This prospective observational study was conducted at the general surgical department of Mymensingh Medical College Hospital from January 2023 to December 2023. A total number of 70 elderly patients who had acute cholecystitis (symptomatic gallstone disease) were included in this study. Based on physical examination, general conditions, laboratory investigation, and radiographic results, gallstone disease was diagnosed. All cases provided a signed, informed consent form. The research was done after approval of the ethical committee. Results: Among the 70 patients the majority of patients (87.14%) fall within the 60-69 years age range. A smaller proportion of older patients: A smaller percentage (12.86%) of patients are aged 70 years or older. The majority of the patients (68.30%) were male and (32.70%) were female. Hypertension is the most prevalent comorbidity among the patients, approximately 15.6% of the patients. Diabetes mellitus follows as the second most common comorbidity, with 11.1% of patients Cardiac disease is the third most frequent comorbidity, present in 6.7% of the patients. Peripheral vascular disease is the least common comorbidity among those presented, affecting 4.4% of the patients. Regarding the symptoms and clinical presentation, patients exhibited a variety of the usual gallbladder disease symptoms, including epigastric pain (51.30%), fatty food intolerance (37.14%), nausea and vomiting (24.29%), Murphy’s sign (14.29%), biliary colic (32.86%), right upper ......

Outcomes of laparoscopic cholecystectomy in elderly patients

Background Laparoscopic cholecystectomy (LC) is the conventional therapy for both symptomatic gallbladder stones and acute cholecystitis; nevertheless, these outcomes are representative of the overall population. Our study’s objective was to evaluate the efficacy of LC in individuals aged 60 and older. Methods This prospective research was performed on 200 elderly cases aged 60 or older who underwent LC. Cases were classified into two groups regarding the age, group (A): Cases aged greater than or equal to 70 years and group (B) Cases aged 60 −less than or equal to 69 years. Group (A) were subdivided into three groups: age from 70 to 72 years (group A1), age from 73 to 76 (group A2), and age from 77 to 80 (group A3) were the additional age categories created from the original group of patients. Results American Society of Anaesthesiologists (ASA) score increased with age in both groups. In group B, 15.5% had ASA scores greater than or equal to 3, and increased to 37.5% in group A1, 68.8% in group A2 and 80.0% in group A3. ASA classification was significantly different between both groups (P<0.001). Acute cholecystitis was found in 8 (17.8%) patients in group A and 24 (15.48%) patients in group B whereas chronic cholecystitis was found in 37 (82.2%) patients in group A and 131 (84.5%) patients in group B, with no significant difference between both groups (P=0.890). The majority of surgically treated patients in all research groups were diagnosed with chronic cholecystitis. Conclusion LC in elderly patients is applicable with low mortality and morbidity rates. Despite the common prevalence of concurrent disorders involving the lung, heart, and diabetes mellitus (DM) in geriatric patients treated with LC, these medical conditions contributed slightly to the morbidity findings.

Comparisons of Mechanical Power and Respiratory Mechanics in Pressure-Controlled Ventilation and Volume-Controlled Ventilation during Laparoscopic Cholecystectomy in Elderly Patients

We compared the effects of pressure-controlled volume-guaranteed ventilation (PCV) and volume-controlled ventilation (VCV) on respiratory mechanics and mechanical power (MP) in elderly patients undergoing laparoscopy. Fifty patients aged 65-80 years scheduled for laparoscopic cholecystectomy were randomly assigned to either the VCV group (n = 25) or the PCV group (n = 25). The ventilator had the same settings in both modes. The change in MP over time was insignificant between the groups (p = 0.911). MP significantly increased during pneumoperitoneum in both groups compared with anesthesia induction (IND). The increase in MP from IND to 30 min after pneumoperitoneum (PP30) was not different between the VCV and PCV groups. The change in driving pressure (DP) over time were significantly different between the groups during surgery, and the increase in DP from IND to PP30 was significantly higher in the VCV group than in the PCV group (both p = 0.001). Changes in MP during PCV and VCV were similar in elderly patients, and MP increased significantly during pneumoperitoneum in both groups. However, MP did not reach clinical significance (≥12 J/min). In contrast, the PCV group had a significantly lower increase in DP after pneumoperitoneum than the VCV group.

Efficacy of blood parameters as indicators of the need for overdue urgent cholecystectomy in elderly patients with acute cholecystitis.

Although early cholecystectomy is recommended for patients with acute cholecystitis, conservative treatment followed by delayed cholecystectomy (DC) is a highly preferred modality, especially in older adult patients. However, some severe cases require overdue urgent cholecystectomy (OC). This study aimed to evaluate the ability of laboratory findings and Tokyo severity classification (TokyoSC) to differentiate those with the need for OC among elderly patients. Laboratory/radiological/clinical findings of geriatric patients with acute cholecystitis on admission and TokyoSC were retrospectively analyzed. The DC and OC groups were compared. The mean age of the 164 patients was 72.3±6.4 years. White blood cell, neutrophil (NEU), immature granulocyte (IG), C-reactive protein, neutrophil-to-lymphocyte ratio (NLR), and TokyoSC parameters were all significant at P<0.001 in differentiation. NLR had a specificity of 98%, and TokyoSC had a sensitivity of 98%. NLR, NEU, IG, and TokyoSC were effective in differentiating patients who needed OC while planning conservative treatment + DC for older adult patients who were followed up due to acute cholecystitis. If the NLR is >9.9 and TokyoSC is moderate/high, early cholecystectomy should be preferred instead of conservative treatment + DC in aged patients.

The Safety of Minimally Invasive and Open Cholecystectomy in Elderly Patients With Acute Cholecystitis: A Systematic Review.

Elderly patients with acute cholecystitis (AC) often receive no surgical treatment due to a high number of comorbidities and a high risk of operations. With an increasingly aged population worldwide, this systematic review aims to review the safety of minimally invasive cholecystectomy and open cholecystectomy in this population compared to younger patients. A systematic search was conducted on PubMed, PubMed Central, and Google Scholar databases on July 2, 2022. Articles in the English language published in the last five years with free full text and involving elderly patients with AC treated with minimally invasive and open cholecystectomy were selected. Moreover,a quality assessment was carried out by using each study's most commonly used assessment tools. Initially, the search yielded 1,252 potentially relevant articles. After the final selection process, 11 studies were included: one cross-sectional study, eight cohort studies, one case-control study, and one systematic review with meta-analyses. These studies involved a total of 378,986 participants, with 375,623 elderly patients. In the elderly, cholecystitis severity, decreased physical status, and multiple comorbidities increase the risk of complications with cholecystectomy. In addition, the elderly had more complications, open surgery conversions, biliary tract injuries, leaks, postoperative mortality, and hospitallength of stay than younger patients. Nevertheless, minimally invasive cholecystectomy is a viable treatment option for elderly patients when performing a thorough perioperative assessment.

Clinical outcomes and feasibility of laparoscopic cholecystectomy in elderly patients

Clinical outcomes and feasibility of laparoscopic cholecystectomy in elderly patients

Clinical impacts of postoperative delirium after cholecystectomy in elderly patients

Clinical impacts of postoperative delirium after cholecystectomy in elderly patients

Risk factors and clinical outcomes of laparoscopic cholecystectomy in elderly patients

Risk factors and clinical outcomes of laparoscopic cholecystectomy in elderly patients

Postoperative Outcomes after Laparoscopic Cholecystectomy in Elderly Patients

Background: Age is a critical factor influencing the death and morbidities afterward cholecystectomy. It was revealed that laparoscopic cholecystectomy (LC) in the elderly has similar security and effectiveness to those in young people. The gold-standard in the management of cholelithiasis is LC. Objectives: This work was aimed to assess post-operative outcomes of LC between elderly cases and for comparing the post-operative outcome of LC among ages groups >60yrs and <60yrs. Patients and Methods: This prospective study conducted among 68 cases who experienced LC at Damanhur Medical National Institute Hospital. Cases were allocated into 2 groups according to ages: elderly (≥60yrs, n= 38) and young (<60 yrs, n= 35). Results: 68 cases divided into two groups. The mean age is 68.4± 5.7 and 49.1± 10.5 among elderly and younger groups. There is significant difference between groups regarding age and comorbidities. The mean operative time was 62.8± 21.2 and 59.5± 18.7 among elderly and young groups. There is no statistically significant difference between two groups regarding intraoperative data. There is nonsignificant change regarding post-operative outcomes after LC. Conclusion: It could be concluded that laparoscopic cholecystectomy in elderly cases is similar with young cases. Consequently, LC is secure even in the elderly.

Analysis of Laparoscopic Cholecystectomy for Elderly Patients with Acute Cholecystitis

Analysis of Laparoscopic Cholecystectomy for Elderly Patients with Acute Cholecystitis

Stress response and state of cognitive functions in the perioperative period in elderly patients during laparoscopic cholecystectomy

The aim. To investigate the dynamics of stress markers and the state of cognitive functions in the perioperative period during laparoscopic cholecystectomy in elderly patients.&#x0D; Materials and methods. We examined 84 patients aged 68.1 ± 0.6 years, with diagnosed gallstone disease, acute cholecystitis, who underwent laparoscopic cholecystectomy. Patients were randomized into 2 groups: Group I - inhalation anesthesia based on sevoflurane with mechanical ventilation; Group II - TBA based on propofol with mechanical ventilation. Hemodynamic parameters, dynamics of stress markers (cortisol, insulin, glucose) and cognitive function were investigated.&#x0D; Results. Glucose and insulin levels in both groups remained within normal limits at all stages of the study. The baseline cortisol level was higher than normal in both groups, but at 4, 5, 6 stages of the study decreased significantly compared with baseline values (p&lt;0.001).&#x0D; In the study of cognitive functions by the Luria test and the MMSE scale, a significant decrease was found in both groups on the day after surgery.&#x0D; According to the Luria test, the score in group I significantly decreased the day after surgery against the period before premedication by 8.7% (p&lt;0.001), in group II - by 10.1% (p&lt;0.001); according to the MMSE scale, the score in group I significantly decreased on the day after surgery against the period before premedication by 6.0% (p&lt;0.001), in group II - by 6.3% (p&lt;0.001).&#x0D; On the fifth postoperative day, no significant differences in baseline values ​​between the Luria test and the MMSE scale were detected.&#x0D; Conclusions. The comparative analysis of the dynamics of stress marker levels in both groups revealed some advantages of general sevoflurane-based anesthesia in antistress protection of patients in the perioperative period during laparoscopic cholecystectomy compared with total intravenous anesthesia based on propofol. However, the effectiveness of anti-stress protection of both types of anesthesia was sufficient.&#x0D; According to the correlation analysis, an inverse correlation was found between the state of cognitive functions in the postoperative period and the level of cortisol in the intraoperative period

Clinical Safety of Laparoscopic Cholecystectomy in Elderly Patients: A Comparison of Clinical Outcomes in Patients Aged 65 to 79 Years and over 80 Years

Clinical Safety of Laparoscopic Cholecystectomy in Elderly Patients: A Comparison of Clinical Outcomes in Patients Aged 65 to 79 Years and over 80 Years

Можливості сучасного анестезіологічного забезпечення лапароскопічної холецистектомії у пацієнтів похилого віку

Можливості сучасного анестезіологічного забезпечення лапароскопічної холецистектомії у пацієнтів похилого віку

Hemodynamic evaluation of elderly patients during laparoscopic cholecystectomy.

to demonstrate hemodynamic changes during laparoscopic cholecystectomy in elderly patients with trans-esophageal echocardiography. we studied 31 elderly patients (aged 60 years or older), ASA I or II, who underwent elective laparoscopic cholecystectomy under general, standardized anesthesia, with cardiovascular parameters measured using transesophageal echocardiography at three different times: before the pneumoperitoneum (T1), after CO2 insufflation (T2) and at deflation (T3). We statistically evaluated changes in systolic, diastolic and mean blood pressure, heart rate, cardiac output and index, and ejection fraction. although small, only the diastolic blood pressure (DBP) and ejection fraction (EF) variations were statistically significant. The mean ± standard deviation of DBP in mmHg at the different times were: T1=67.5±10.3; T2=73.6±12.4; and T3=66.7±9.8. And for EF, in percentage (%) they were: T1=66.7±10.4; T2=63.2±9.9; and T3=68.1±8.4. There was no statistical correlation between hemodynamic variations, age and number of patients' comorbidities. laparoscopic cholecystectomy causes few hemodynamic changes that are well tolerated by the majority of the elderly patients; prior impairment of ventricular function represents a threat in elderly patients during surgery; there appears to be a lower hemodynamic effect caused by the pneumoperitoneum than by the patient's positioning in a reverse Trendelemburg during surgery.

Prediction on surgical outcomes of videolaparoscopic cholecystectomy in elderly patients using comorbidity combined score

Prediction on surgical outcomes of videolaparoscopic cholecystectomy in elderly patients using comorbidity combined score

Clinical outcomes of laparoscopic cholecystectomy in elderly patients after preoperative assessment and optimization of comorbidities.

Backgrounds/AimsEarly laparoscopic cholecystectomy is considered as the standard treatment of acute cholecystitis. However, whether this procedure is desirable in elderly patients with acute cholecystitis is not clearly elucidated. In this study, we aimed to evaluate the effects of thorough preoperative assessment and consultation for complications on clinical outcomes in elderly patients over 65 and over 80 years.MethodsWe retrospectively analyzed 205 patients who were diagnosed with acute cholecystitis between January 2010 and April 2018. The patients were assigned to three groups: group A (aged <65 years), group B, (aged between 65 and 79 years), and group C (aged >79 years). Laparoscopic cholecystectomy was performed after preoperative evaluation, such as echocardiography, pulmonary function test, and consultation about past history.ResultsSignificant differences were not found in the complication rate among the age groups. Open conversion was required in eight of the 114 patients in group A, seven of the 70 patients in group B, and one of the 21 patients in group C. However, no statistical significance was found. Moreover, no difference was noted in the start of the meal and the period from surgery to last visit, but hospital stay after surgery was longer in groups b and c.ConclusionsWhen sufficient preoperative assessment and treatment were performed, complication and conversion rates were not significantly different among the age groups. In extremely elderly patients, preoperative evaluation and elective laparoscopic cholecystectomy were desirable.

Feasibility and safety of single-incision laparoscopic cholecystectomy in elderly patients: A single institution, retrospective case series.

IntroductionTo evaluate the feasibility and safety of single-incision laparoscopic cholecystectomy (SILC) for uncomplicated gallbladder in elderly patients.Materials and MethodsA retrospective analysis of 810 patients undergoing SILC from May 2009 to October 2016 at Osaka Police Hospital was performed, and the outcomes of the patients aged < 80 years and the patients ≥ 80 years were compared.ResultsThe median operative times of patients <80 years and patients ≥80 years were 100 min and 110 min, respectively (p = 0.4). The conversion rates to a different operative procedure (multi-port laparoscopic cholecystectomy or open cholecystectomy) were 3% (22/763) of patients < 80 years and 0% of patients ≥ 80 years (p = 0.6). Perioperative complications were seen in 6% (46/763) of patients < 80 years and 17% (8/47) of patients ≥ 80 years (p < 0.05). Pneumonia was seen in 0% (0/763) of patients < 80 years and 4% (3/47) of patients ≥ 80 years (p < 0.05). There was no mortality in either group. The median postoperative hospital stay was 4 days for patients <80 years and 5 days for patients ≥80 years (p < 0.05).ConclusionSILC for uncomplicated gallbladder could be performed for patients ≥ 80 years with acceptable morbidity and mortality as compared with the previous reports, though the complication rate of patients ≥ 80 years was higher than that of patients < 80 years.

Effect of propofol, sevoflurane, and isoflurane on postoperative cognitive dysfunction following laparoscopic cholecystectomy in elderly patients: A randomized controlled trial

Study objectiveTo compare the incidence of postoperative cognitive dysfunction (POCD) in elderly surgical patients (>60years) receiving different anesthetics (propofol, sevoflurane, or isoflurane) and to identify potential biomarkers of POCD in this patient population. DesignProspective, randomized, double-blind clinical trial. SettingUniversity-affiliated teaching hospital. PatientsOne hundred and fifty elderly patients scheduled for laparoscopic cholecystectomy. InterventionsElderly patients undergoing laparoscopic cholecystectomy were randomly assigned to receive propofol, sevoflurane, or isoflurane anesthesia. Measurements: Cognitive function was assessed using neuropsychological tests at baseline (1day before surgery [D0]), and on postoperative day 1 (D1) and day 3 (D3). Plasma S-100β and Aβ1–40 protein, IL-1β, IL-6 and TNF-α concentrations were assessed before induction of anesthesia (T0), after extubation (T1), and 1h (T2) and 24h (T3) postoperatively. Main resultsThe incidence of POCD was significantly lower in the propofol group compared to the isoflurane group and the sevoflurane group at D1 and D3 (propofol vs. isoflurane: D1 and D3, P<0.001; propofol vs. sevoflurane: D1, P=0.012; D3, P=0.013). The incidence of POCD was significantly lower in the sevoflurane group compared to the isoflurane group at D1 (P=0.041), but not at D3. Postoperatively, plasma S-100β and Aβ1–40 protein, IL-1β, IL-6, and TNF-α concentrations were significantly decreased in the propofol group compared to the isoflurane group. ConclusionsPropofol anesthesia may be an option for elderly surgical patients.

Early Cholecystectomy for Acute Cholecystitis in the Elderly Population: A Systematic Review and Meta-Analysis

Background: In the era of advanced surgical techniques and improved perioperative care, the willingness to perform emergency operations in elderly patients continues to increase. This systematic review aimed at assessing the clinical outcomes of early cholecystectomy in elderly patients with acute cholecystitis. Methods: Medline, Embase, and Cochrane Library databases were systematically searched for studies reporting on early cholecystectomy for acute cholecystitis in patients aged ≥70 years. The conversion rate, perioperative morbidity, and mortality were calculated using a random-effects model. Results: Eight articles fell within the scope of this study. In total, 592 patients were identified. The mean age was 81 years. Early cholecystectomy was performed laparoscopically in 316 patients (53%) and open in 276 patients (47%). The procedure was associated with a conversion rate of 23% (95% CI 18.6-28.3), a perioperative morbidity of 24% (95% CI 20.5-27.5), and a mortality of 3.5% (95% CI 2.3-5.4). Conclusion: Early cholecystectomy seems to be a feasible treatment in elderly patients with acute cholecystitis. To reduce morbidity, patients who may benefit from surgery ought to be selected carefully. Future prospective studies should compare early cholecystectomy with alternative treatments to select the treatment that is most appropriate for elderly patients.

Peer review report 1 on “Feasibility And Safety Of Single-Incision Laparoscopic Cholecystectomy In Elderly Patients: A Single Institution, Retrospective Case Series”

Peer review report 1 on “Feasibility And Safety Of Single-Incision Laparoscopic Cholecystectomy In Elderly Patients: A Single Institution, Retrospective Case Series”