Skip to main content

Elective and emergency laparoscopic cholecystectomy in the elderly: early or delayed approach

Background

Comparing outcomes of the first Division of Abdominal Surgery of the Saint Louis Hospital of Orbassano (Turin) with the literature, regarding timing and technique of early or delayed laparoscopic cholecystectomy in the management of acute cholecystitis in elderly patients.

Materials and methods

From January 2005 to December 2009 114 laparoscopic cholecystectomy in the elderly were performed in our surgical division: 67 for gallbladder stones and 47 for acute cholecystitis.

The diagnosis of cholecystitis and gallbladder stones was based on general condition, physical examination, laboratory, radiological findings and sepsis score. For the study we’ve also considered: total hospital stay, timing after and before the operation, kind and duration of operation, conversion to the open procedure, drain and final pathological results.

From this study 29 patients were excluded (17 for choledocolytiasis associated and 12 for hospitalisation > 20 days). We hadn’t excluded patients ASA III and ASA IV: in these patients (27.4 %, 17 ASA III and 4 ASA IV) abdominal pressure not superior of 10 mmHg was used [1].

Elderly patients included in the study were 85 (49 M, 36 F). Ordinary Cholecystectomy were peformed in 45 cases and Emergency Cholecystectomy in 40 cases. This last group was further divided into two groups [24]: DEA Early, E-DLC, (31 patients operated on within 72 hours from onset of symptoms) and DEA Delayed, D-DLC, (9 patients operated on after 72 hours to 9 days from onset of symptoms).

We’ve also considered the operating team (Table 1) that performed the operation because the first operator’s experience was considered as an important factor in order to evaluate our results [511].

Table 1 Definitions of equipes.

Results

The comparison between elective and emergency operations showed that drain placement and post operation hospital stay were found statistically significant in the emergency group (Table 2). There weren’t any differences regarding team evaluation (Table 3). Concerning the analysis of the E-DLC and D-DLC groups there aren’t any statistical differences (Table 4).

Table 2 Ord/DEA.
Table 3 Equipes.
Table 4 E-DLC/D-DLC.

Conclusions

In contrast with other authors [12, 13], laparoscopic cholecystectomy in our elderly patients, when performed with an adequate technique, represents a safe procedure to treat all cases of acute cholecystitis in an emergency setting [1422]. Our technique represents a standardized surgical strategy to approach acute cholecystitis and cholelytiasis in the elderly in a safe, effective and reproducible manner.

References

  1. 1.

    Catani M, Modini C: Laparoscopic cholecystectomy in acute cholecystitis: a proposal of safe and effective technique. Hepatogastroenterology. 2007, 54 (80): 2186-91.

    PubMed  Google Scholar 

  2. 2.

    Chung-Mau Lo, Chi-Leung Liu, Sheung-Tat Fan, Edward C S Lai, John Wong: Prospective Randomized Study of Early Versus Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis. Ann Surg. 227 (4): 461-467.

  3. 3.

    Litwin DE, Cahan MA: Laparoscopic cholecystectomy. Surg Clin North Am. 2008, 88 (6): 1295-313.

    Article  PubMed  Google Scholar 

  4. 4.

    Wilson E, Gurusamy K, Gluud C, Davidson BR: Cost–utility and value-of-information analysis of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg. 2010, 97: 210-219.

    CAS  Article  PubMed  Google Scholar 

  5. 5.

    Dàvila D, Manzanares C, Picho –ML, Albors P, Cardenas F, Fuster E: Experience in the treatment (early vs. delayed) of acute cholecystitis via laparoscopy. Cirugia Espanola. 1999, 66: 233-

    Google Scholar 

  6. 6.

    Bohacek L, MD David, E Pace: Advanced laparoscopic training and outcomes in laparoscopic cholecystectomy. Can J Surg. 2009, 52: 4-

    Google Scholar 

  7. 7.

    Ballantyne GH, Ewing D, Capella RF: The learning curve measured by operating times for laparoscopic and open gastric bypass: roles of surgeon’s experience, institutional experience, body mass index and fellowship training. Obes Surg. 2005, 15: 172-82.

    Article  PubMed  Google Scholar 

  8. 8.

    Gill J, Booth MI, Stratford J, Dehn TC: The extended learning curve for laparoscopic fundoplication: a cohort analysis of 400 consecutive cases. J Gastrointest Surg. 2007, 11: 487-92.

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  9. 9.

    Avital S, Hermon H, Greenberg R, Karin E, Skornick Y: Learning curve in laparoscopic colorectal surgery: our first 100 patients. Isr Med Assoc J. 2006, 8 (10): 683-6.

    PubMed  Google Scholar 

  10. 10.

    Soot SJ, Eshraghi N, Farahmand M, Sheppard BC, Deveney CW: Transition from open to laparoscopic fundoplication: the learning curve. Arch Surg. 1999, 134 (3): 278-81.

    CAS  Article  PubMed  Google Scholar 

  11. 11.

    Li GX, Yan HT, Yu J, Lei ST, Xue Q, Cheng X: Learning curve of laparoscopic resection for rectal cancer. Nan Fang Yi Ke Da Xue Xue Bao. 2006, 26 (4): 535-8.

    PubMed  Google Scholar 

  12. 12.

    Kauvar DS, Brown BD, Braswell AW, Harnisch MJ: Laparoscopic cholecystectomy in the elderly: increased operative complications and conversions to laparotomy. Laparoendosc Adv Surg Tech A. 2005, 15 (4): 379-82.

    Article  Google Scholar 

  13. 13.

    Moyson J, Thill V, Simoens Ch, Smets D, Debergh N, Mendes da Costa P: Laparoscopic cholecystectomy for acute cholecystitis in the elderly: a retrospective study of 100 patients. Hepatogastroenterology. 2008, 55 (88): 1975-80.

    CAS  PubMed  Google Scholar 

  14. 14.

    Lau H, Lo CY, Patil NG, Yuen WK: Early versus delayed-interval laparoscopic cholecystectomy for acute cholecystitis: a metaanalysis. Surg Endosc. 2006, 20 (1): 82-7.

    CAS  Article  PubMed  Google Scholar 

  15. 15.

    Johansson M, Thune A, Blomqvist A, Nelvin L, Lundell L: Management of acute cholecystitis in the laparoscopic era: results of a prospective, randomized clinical trial. J Gastrointest Surg. 2003, 7: 642-645.

    Article  PubMed  Google Scholar 

  16. 16.

    Lo C, Liu C, Fan ST, Lai EC, Wong J: Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Ann Surg. 1998, 227: 461-467.

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  17. 17.

    Polychronidis A, Botaitis S, Tsaroucha A, Tripsianis G, Bounovas A, Pitiakoudis M, Simopoulos C: Laparoscopic cholecystectomy in elderly patients. J Gastrointestin Liver Dis. 2008, 17 (3): 309-13.

    PubMed  Google Scholar 

  18. 18.

    Kirshtein B, Bayme M, Bolotin A, Mizrahi S, Lantsberg L: Laparoscopic cholecystectomy for acute cholecystitis in the elderly: is it safe?. Surg Laparosc Endosc Percutan Tech. 2008, 18 (4): 334-9.

    Article  PubMed  Google Scholar 

  19. 19.

    Majeski J: Laparoscopic cholecystectomy in geriatric patients. Am J Surg. 2004, 187 (6): 747-50.

    Article  PubMed  Google Scholar 

  20. 20.

    Stanisić V, Bakić M, Magdelinić M, Kolasinac H, Miladinović M: Laparoscopic cholecystectomy in elderly patients. Acta Chir Iugosl. 2009, 56 (2): 87-91.

    Article  PubMed  Google Scholar 

  21. 21.

    Tambyraja AL, Kumar S, Nixon SJ: Outcome of laparoscopic cholecystectomy in patients 80 years and older. World J Surg. 2004, 28 (8): 745-8.

    Article  PubMed  Google Scholar 

  22. 22.

    Behrman SW, Melvin WS, Babb ME, Johnson J, Ellison EC: Laparoscopic cholecystectomy in the geriatric population. Am Surg. 1996, 62 (5): 386-90.

    CAS  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to A Ferrarese.

Rights and permissions

This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Reprints and Permissions

About this article

Cite this article

Ferrarese, A., Martino, V. & Nano, M. Elective and emergency laparoscopic cholecystectomy in the elderly: early or delayed approach. BMC Geriatr 11, A14 (2011). https://doi.org/10.1186/1471-2318-11-S1-A14

Download citation

Keywords

  • Laparoscopic Cholecystectomy
  • Cholecystitis
  • Acute Cholecystitis
  • Team Evaluation
  • Drain Placement