Clinical outcome for laparoscopic cholecystectomy in extremely elderly patients

Lee, Sang-Ill; Na, Byung-Gon; Yoo, Youngsun; Mun, Seong-Pyo; Choi, Nam Kyu

doi:10.4174/astr.2015.88.3.145

Cited by 40 publications

(49 citation statements)

References 27 publications

(46 reference statements)

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“…Preoperative cholecystostomy is useful procedure when the patient's condition is poor or the age is too old [19]. Although we excluded septic patient with cholecystitis, it is not uncommon clinical scenario.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of subtotal cholecystectomy performed for difficult cholecystectomy

et al. 2016

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PurposeLaparoscopic subtotal cholecystectomy (LSC) can be an alternative surgical technique for difficult cholecystectomies. Surgeons performing LSC sometimes leave the posterior wall of the gallbladder (GB) to shorten the operation time and avoid liver injury. However, leaving the inflamed posterior GB wall is a major concern. In this study, we evaluated the clinical outcomes of standard laparoscopic cholecystectomy (SLC), LSC, and LSC removing only anterior wall of the GB (LSCA).MethodsWe retrospectively reviewed the medical records of laparoscopic cholecystectomies performed between January 2006 to December 2015 and analyzed the outcomes of SLC, LSC, and LSCA.ResultsA total of 1,037 patients underwent SLC. 22 patients underwent LSC; and 27 patients underwent LSCA. The mean operating times of SLC, LSC, and LSCA were 41, 74, and 68 minutes, respectively (P < 0.01). Blood loss was 5, 45, and 33 mL (P < 0.05). The mean lengths of postoperative hospitalization were 3.4, 5.4, and 5.8 days. Complications occurred in 24 SLC patients (2.3%), 2 LSC patients (9%), and 1 LSCA patient (3.7%). There was no mortality among the LSC and LSCA patients.ConclusionLSC and LSCA are safe and feasible alternatives for difficult cholecystectomies. These procedures help surgeons avoid bile duct injury and conversion to laparotomy. LSCA has the benefits of shorter operation time and less bleeding compared to LSC.

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Section: Discussionmentioning

confidence: 99%

Clinical outcomes of subtotal cholecystectomy performed for difficult cholecystectomy

et al. 2016

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“…There is no definitive view on the upper age limit for patients undergoing LC. The oldest patients were a 96-year-old reported by Lee et al[10] and a 102-year-old reported in China[45]. In our study, 112 patients underwent LC (including 7 patients who underwent LC + EST/EPBD)[46,47], with a success rate of 100%, and none of the patients were converted to laparotomy.…”

Section: Discussionmentioning

confidence: 77%

“…In particular, a subset of elderly patients may be at higher risk of developing postoperative complications and increased mortality due to the loss of physiological function and physical reserves[4,5]. Therefore, there is an unmet clinical need to characterize biliary diseases in elderly patients, in order to improve diagnosis and treatment for these diseases[6-10]. …”

Section: Introductionmentioning

confidence: 99%

Therapeutic experience of 289 elderly patients with biliary diseases

Zhang

Liu

et al. 2017

WJG

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AIMTo present clinical characteristics, diagnosis and treatment strategies in elderly patients with biliary diseases.METHODSA total of 289 elderly patients with biliary diseases were enrolled in this study. The clinical data relating to these patients were collected in our hospital from June 2013 to May 2016. Patient age, disease type, coexisting diseases, laboratory examinations, surgical methods, postoperative complications and therapeutic outcomes were analyzed.RESULTSThe average age of the 289 patients with biliary diseases was 73.9 ± 8.5 years (range, 60-102 years). One hundred and thirty-one patients (45.3%) had one of 10 different biliary diseases, such as gallbladder stones, common bile duct stones, and cholangiocarcinoma. The remaining patients (54.7%) had two types of biliary diseases. One hundred and seventy-nine patients underwent 9 different surgical treatments, including pancreaticoduodenectomy, radical resection of hilar cholangiocarcinoma and laparoscopic cholecystectomy. Ten postoperative complications occurred with an incidence of 39.3% (68/173), and hypopotassemia showed the highest incidence (33.8%, 23/68). One hundred and sixteen patients underwent non-surgical treatments, including anti-infection, symptomatic and supportive treatments. The cure rate was 97.1% (168/173) in the surgical group and 87.1% (101/116) in the non-surgical group. The difference between these two groups was statistically significant (χ2 = 17.227, P < 0.05).CONCLUSIONActive treatment of coexisting diseases, management of indications and surgical opportunities, appropriate selection of surgical procedures, improvements in perioperative therapy, and timely management of postoperative complications are key factors in enhancing therapeutic efficacy in elderly patients with biliary diseases.

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“…[27][28][29][30] However, as many older patients present with conditions that increase surgery risk, or directly refuse surgical treatment, a conservative treatment sometimes has to be considered, which could lead to a prolonged hospital stay. Studies have demonstrated that early cholecystectomy is associated with shorter hospital stay, lower complication rates and reduced hospital spending.…”

Section: Discussionmentioning

confidence: 99%

Home hospitalization for the surgical and conservative treatment of acute calculous cholecystitis

et al. 2018

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Aim: Acute calculous cholecystitis is a frequent complication of gallstones that can manifest in up to 10-15 per cent of previously asymptomatic patients. Current guidelines recommend laparoscopic cholecystectomy as the gold standard treatment; however, the presence of surgery risk factors might compel physicians to opt for conservative treatment, which is often associated with longer hospital stay. Home hospitalization could be an alternative to inpatient stay for these patients. Patients and Methods: The present study was a retrospective analysis of data from a prospective patient single-centre registry. Data from 915 patients with mild or moderate acute calculous cholecystitis, who presented in the Department of General Surgery of our hospital between 2010 and 2015, were analysed. The variables included grade of acute cholecystitis, type of treatment, use of antibiotics, inpatient stay, stay in hospital-at-home, complications, mortality, readmissions and relapse. Results: A total of 147 (16 per cent) patients were referred to hospital-at-home, while the rest completed their treatment in the hospital ward. There were no significant differences between the home hospitalization and conventional hospitalization groups in the rates of complications, mortality, readmissions, relapse and length of antibiotherapy. Home hospitalization was associated with shorter inpatient stay, but longer total hospitalization, likely due to a prolonged follow up by the home care unit. Conclusions: Home hospitalization is an effective and safe alternative to conventional hospitalization, as it provides hospital-level care and reduces the number of admissions and length of inpatient stay. The timely referral of patients to other levels of assistance, such as primary care, is needed to ensure economic benefits of home hospitalization programmes.

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Clinical outcome for laparoscopic cholecystectomy in extremely elderly patients

Cited by 40 publications

References 27 publications

Clinical outcomes of subtotal cholecystectomy performed for difficult cholecystectomy

Clinical outcomes of subtotal cholecystectomy performed for difficult cholecystectomy

Therapeutic experience of 289 elderly patients with biliary diseases

Home hospitalization for the surgical and conservative treatment of acute calculous cholecystitis

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