Laparoscopic Cholecystectomy in Geriatric Patients

Burhan Mayir, Yeliz Akp?nar Mayir, Cemal Ozben Ensari, Umut R?za Gunduz, Arif Aslaner, Ugur Dogan, Tugrul Cakir, Umit Koc, Mehmet Tahir Oruc. Antalya Training and Research Hospital, Department of General Surgery

Introduction

Postoperative morbidity and mortality are more frequent in the ageing than in the young population due to reasons such as decreased organ function, accompanying disorders, and malnutrition. Laparoscopic interventions on the elderly patients can be additional causes of morbidity and mortality The purpose of this study was to assess the safety of laparoscopic cholecystectomy (LC) in the aged and the very aged patients

Materials and Method

The patients were studied in 3 groups based on age. Group 1 consisted of patients aged under 65, Group 2 comprised patients of age 65-79, and Group 3 comprised patients of age 80 and over. Each group included 50 consecutive patients who had undergone LC in our clinic.

Results

There were differences between the groups in terms of the preoperative levels of hemoglobin and albumin, the ASA score, presence of hypertansion, presence of coroner artery disease (CAD), presence of chronic obstrucitve pulmonary disease (COPD), length of hospitalization, rate of emergency cholecystectomy, and the morbidity rate.

Morbidity was seen in 13 (8.7%) patients, with pulmonary complications in 6, cardiac complications in 5, and infectious complications in 2. There was no mortality in the study groups. The rate of morbidity was significantly higher in patients aged over 80 than in the other patients (p=0.001). The presence rates of COPD, CAD, low hemoglobin, low albumin, and high ASA score were found to be higher in patients with morbidity. The logistic regression analysis showed that the presence of COPD and low albumin level were associated with morbidity.

Discussion

Very old patients for whom cholecystectomy has been planned, LC could be performed safely. Laparoscopic cholecystectomy should be performed after a thorough evaluation of the patients and fulfilling the required preparations, since the most important factors associated with morbidity and mortality are co-existing disorders and the nutritional status.