Although laparoscopic cholecystecto...

Although laparoscopic cholecystectomy has become standard treatment for symptomatic cholecystitis, little attention has been paid to its use in geriatric patients. This course has a higher incidence of biliary injuries than the traditional lay open cholecystectomy, and most reports concerning somewhat old patients have focused on complications, morbidity, mortality, and rates of conversion to exhibit procedures. The reports also affect selected patients treated at academic health center where various evens of residents perform the surgeries. Majeski reports in succession a series of 82 patients 65 years or older who underwent laparoscopic cholecystectomy for symptomatic gallbladder disease; the surgeries were performed by the agency of a single surgeon in a community surgical practice.

The patients were part of a series of 248 adults who were treated with laparoscopic cholecystectomy between 1990 and 2002 All patients were referr for surgery because of symptomatic cholecystitis or biliary colic, and all surgeries were performed using a standard technique. Of the 86 patients older than 65 years, four required conversion to exhibit cholecystectomy. Sixty-two of the 82 geriatric patients who underwent laparoscopic cholecystectomy were women and above one half (47 patients)were between 65 and 74 years of age. Eleven patients were older than 85 years. Elective actions were more common in the 65-to 74-year-old patients (37 of 47 cases), whereas turn of events surgeries were required in nine of the 11 patients older than 85 years. The consideration patients were generally healthy. Overall, 56 were in category I or II of the American Association of Anesthesiologists (ASA) physical status classification, on the other hand nine of the 11 patients older than 85 years were in category III or IV.

The rate of conversion to lay open cholecystectomy in geriatric patients was 3 6 percent--identical to that of the entire series. brace thirds of geriatric patients were discharged upon the first postoperative day, and 24 percent onward the second day. The couple deaths occurred following converted operations in patients with ASA III classifications. united death was caused by widespread carcinoma of the gallbladder, and the other occurr in a 91-year-old woman with multiple medical comorbidities and surgical complications. The rate of postoperative complications in geriatric patients was 72 percent (primarily pang infections). Only one patient lay opened postoperative pneumonia. The author individualed patients and found that 90 percent would put off elective gallbladder surgeries until they could obtain a laparoscopic procedure

The author decides that, despite concerns about comorbidities and more challenging surgery because of fibrosis and adhesions following years of gallbladder disease, laparoscopic cholecystectomy is safe and well tolerated in geriatric patients. He commits greater use of elective laparoscopic cholecystectomy in symptomatic geriatric patients to avoid the morbidity and mortality associated with extremity procedures.

Majeski J Laparoscopic cholecystectomy in geriatric patients. Am J Surg June 2004;187:747-50

COPYRIGHT 2005 American Academy of Family Physicians

COPYRIGHT 2005 Gale Group