Laparoscopic cholecystectomy in the elderly

Methods We conducted a retrospective study evaluating the medical records of 40 consecutive patients age 70 or older who underwent laparoscopic cholecystectomy at the Department of Surgical Sciences, Organ Transplantation and Advanced Technologies, Oncology Surgery Unit, University of Catania, Italy. Data included age and gender, American Society of Anaesthesiologists (ASA) score, comorbid illness, prior abdominal surgery, presentation, operative time, conversion rate and reasons for conversion, postoperative morbidity and mortality rates, pathologic diagnosis, and length of hospital stay. Patients were classified as having complicated (acute cholecystitis, biliary pancreatitis, obstructive jaundice, and cholangitis) or uncomplicated (biliary pain) gallstone disease. Ultrasonography evidence of a dilated common duct or presence of common duct stones, serum elevations in alkaline phosphatase, transaminase, or bilirubin were indications for preoperative magnetic resonance cholangiography. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) with removal of possible common duct stones was performed in the patients suspected of having choledocholithiasis. The timing for LC in patients with acute cholecystitis was 24–72 hours from admission. Patients with acute pancreatitis related to gallstone disease underwent surgery after resolution of clinical and biochemical symptoms. The supportive treatment during the acute phase consisted of intravenous infusion, antibiotics, and nasogastric suction when necessary. Early surgery was defined as laparoscopic cholecystectomy during the initial hospitalization usually within 5 days, whereas patients undergoing delayed surgery were treated conservatively, discharged, and readmitted for elective operation. Patients were included if surgery was performed primarily for symptomatic gallstone disease and excluded if cholecystectomy was performed incidentally or secondary to another procedure. Laparoscopic cholecystectomy was performed using a standard four-trocars technique. An "open technique" was used in all cases to introduce the subumbilical cannula as previously described by our group. Dissection of the gallbladder from the liver was accomplished using monopolar electrocautery. Intraoperative cholangiography was performed selectively to assist in defining the anatomy or intraoperative abnormalities. A closed suction drainage was used in all procedures.