Elective and emergency laparoscopic cholecystectomy in the elderly: early or delayed approach
BMC Geriatrics volume 11, Article number: A14 (2011)
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 .
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 [2–4]: 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).
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).
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 [14–22]. Our technique represents a standardized surgical strategy to approach acute cholecystitis and cholelytiasis in the elderly in a safe, effective and reproducible manner.
Catani M, Modini C: Laparoscopic cholecystectomy in acute cholecystitis: a proposal of safe and effective technique. Hepatogastroenterology. 2007, 54 (80): 2186-91.
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.
Litwin DE, Cahan MA: Laparoscopic cholecystectomy. Surg Clin North Am. 2008, 88 (6): 1295-313.
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.
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-
Bohacek L, MD David, E Pace: Advanced laparoscopic training and outcomes in laparoscopic cholecystectomy. Can J Surg. 2009, 52: 4-
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Majeski J: Laparoscopic cholecystectomy in geriatric patients. Am J Surg. 2004, 187 (6): 747-50.
Stanisić V, Bakić M, Magdelinić M, Kolasinac H, Miladinović M: Laparoscopic cholecystectomy in elderly patients. Acta Chir Iugosl. 2009, 56 (2): 87-91.
Tambyraja AL, Kumar S, Nixon SJ: Outcome of laparoscopic cholecystectomy in patients 80 years and older. World J Surg. 2004, 28 (8): 745-8.
Behrman SW, Melvin WS, Babb ME, Johnson J, Ellison EC: Laparoscopic cholecystectomy in the geriatric population. Am Surg. 1996, 62 (5): 386-90.
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 (Suppl 1), A14 (2011). https://doi.org/10.1186/1471-2318-11-S1-A14
- Laparoscopic Cholecystectomy
- Acute Cholecystitis
- Team Evaluation
- Drain Placement