Gallstones in Elderly Patients: Impact of Laparoscopic Cholecystectomy

Abstract

The use of laparoscopic cholecystectomy (LC) in elderly patients may pose problems because of their poor general condition, especially of cardiopulmonary function. Moreover, these patients present with acute cholecystitis and associated common bile duct stones more often than their younger counterparts. From 1990 to 1999, the authors performed 943 LCs; 31 (3.2%) were attempted on elderly patients, 11 (35%) of which were on an emergency basis because of acute cholecystitis, cholangitis or acute biliary pancreatitis. Ten per cent of LCs needed to be converted to an open cholecystectomy, most often because of an increase in the partial pressure of carbon dioxide in the blood produced by excessive operative time. A gasless procedure was used in the last three years of the study on eight cases; the overall rate of conversion from LC to open cholecystectomy in this group was 0%. Associated gallbladder and common bile duct stones were found in five (16%) patients (four preoperative LC endoscopic sphincterotomy and one transcystic approach). The success rate in both of these cases was 100%, overall morbidity was 29% and there was no mortality. These results show that LC is a feasible and safe procedure for use in elderly patients. Gasless LC should be preferred in patients classified as American Society of Anesthesiologists’ class III because an excessive duration of operation is the most common reason for converting to an open cholecystectomy.

Laparoscopic Cholecystectomy for Elderly Patients

“…3 It speaks to the limited physiologic reserve of this patient group but remains below the rate reported for open cholecystectomy. 7 While Uecker et al 5 and Magnuson et al 8 did not see a benefit of LC with respect to morbidity and mortality in the management of acute biliary tract disease in the octogenarian, our data suggest otherwise. Uecker et al reported a complication rate of 56% after laparoscopic intervention and 14% after open cholecystectomy for acute cholecystitis.…”

Acute gallstone cholecystitis in the elderly

“…Several authors [35,39] have reported that LC with intraoperative hemodynamic monitoring can be safely performed in elderly patients; however, it is important to use the gasless technique [26] or a gradual abdominal insufflation with a pressure always <12 mmHg and a limited 10°head-up tilt [9].…”

Laparoscopic cholecystectomy and common bile duct exploration are safe for older patients

“…In the era of laparoscopic cholecystectomy, few studies have reported the results of this procedure in the elderly [4,15], and no study has specifically addressed single-stage laparoscopic management of gallstones and CBD stones in patients of advanced age. The current prospective study aimed to evaluate the results of singlestage laparoscopic cholecystectomy and CBD exploration in a series of unselected patients older than 70 years, and to compare them with the results in a control group of younger patients treated with the same type of approach by the same surgical team during the same period.…”