The Safety of a Laparoscopic Cholecystectomy in Acute Cholecystitis in High Risk Patients Older than Sixty

Purpose: To evaluate the safety of a laparoscopic cholecystectomy in acute, or complicated, cholecystitis in patients older than sixty. Methods: A prospective study was performed, at the Ewha Womans University Mokdong Hospital, on a series of elderly patients (＞60 years; n=137) who had undergone a laparoscopic cholecystectomy due to acute, or complicated, cholecystitis between March 1997 and December 2001. We divided the patients into 3 groups; ASA 1 (n=33, 24.1%), ASA 2 (n=79, 57.7%) and ASA 3 (n=25, 18.3%), according to their ASA (American Society of Anesthesiologist) classification. No patient was categorized as either ASA 4, 5 or 6. Results: The mean age of the ASA 3 patients was 71.96.9 years, which was older than the 65.76.0 years of the ASA 1 patients (P＜0.05). The preoperative hospital stay for the ASA 3 patients was 8.85.6 days, compared to 5.63.7 days for the ASA 1 patients (P＜0.05). The incidences of complicated cholecystitis were lower in the ASA 1 (n=8, 24.2%) than in both the ASA 2 (n=40, 50.6%) and 3 patients (n=12, 66.7%) (P＜0.05). The mean operating times for the ASA 2 and 3 patients were longer, at 111.058.2 and 114.062.7 minutes, retrospectively, than the 85.033.1 minutes for the ASA 1 patients (P＜0.05). Drain insertions were more frequently performed in the ASA 2 (n=33, 44.4%) and 3 (n=15, 60.0%) than in the ASA 1 patients (n=10, 30.3%) (P＜0.05). Postoperative morbidity was more frequent in the ASA 3 (n=5, 20.0%) than ASA 1 (n=3, 9.1%) patients. However, in terms of the postoperative recovery parameters (time to diet, hospital stay), there were no difference between the three groups (P＞0.05). One death, due to acute myocardial infarction, occurred in one of the ASA 3 patients. Conclusion: A laparoscopic cholecystectomy in acute, or complicated, cholecystitis could be an option in elderly-high risk patients.