ABSTRACT
INTRODUCTION: The aim of this study was to assess the influence of age in laparoscopic cholecystectomy (LC) for the treatment of acute cholecystitis by determining the benefits and postoperative complications in patients older than 65 years. MATERIAL AND METHOD: Between January 2003 and March 2006, we performed 134 urgent LC for acute cholecystitis: 58 patients older than 65 years (group 1) were compared with 76 patients younger than 65 years (group 2). Preoperative, intraoperative and postoperative variables were compared between groups 1 and 2. ASA score was used in the preoperative anesthetic evaluation. RESULTS: A total of 31.2% of patients in group 1 had high surgical risk (24% ASA III and 9.2% ASA IV). The conversion rate was 24.1% in group 1 versus 11.3% in group 2 (p = 0.04), due to difficulty in surgical dissection and advanced cholecystitis. The mean length of postoperative hospital stay was 4.7 +/- 3.2 days in group 1 versus 3.3 +/- 2.4 days in group 2 (p = 0.001). The overall rate of postoperative complications was 33.1% and 18.7% respectively, with a predominance of infectious complications. CONCLUSIONS: Although age should not be an exclusion factor for LC, the conversion rate, postoperative complications and length of hospital stay are increased in the elderly. Higher morbidity due to the underlying disease and longer disease duration with more advanced cholecystitis complicate the laparoscopic approach in these patients.
Subject(s)
Cholecystectomy, Laparoscopic/methods , Cholecystitis, Acute/surgery , Aged , Female , Humans , Male , Middle AgedABSTRACT
Introducción. El objetivo de este estudio es valorar la influencia de la edad en la colecistectomía laparoscópica (CL) para el tratamiento de la colecistitis aguda (CTTA), determinando los beneficios y complicaciones postoperatorias en los pacientes mayores de 65 años. Material y método. Entre enero de 2003 y marzo de 2006, se practicó un total de 134 CL por CTTA en el área de urgencias: 58 pacientes tenían edades superiores a 65 años (grupo 1) y se los comparó con 76 pacientes más jovenes (grupo 2). Se analiza las variables preoperatorias, intraoperatorias y postoperatorias en el grupo 1 y se las compara con el resto de la serie. Se utilizó la clasificación ASA para valoración preoperatoria anestésica. Resultados. El grupo 1 presentó en un 31,2% alto riesgo quirúrgico (un 24%, ASA III y el 9,2%, ASA IV). La tasa de conversión a colecistectomía abierta fue del 24,1%, frente al 11,3% en el grupo 2 (p = 0,04), debido a dificultad en la disección quirúrgica y hallazgo de vesícula colecistítica muy evolucionada. La estancia media postoperatoria fue de 4,7 ± 3,2 días en el grupo 1 y de 3,3 ± 2,4 días en el grupo 2 (p = 0,001). La tasa general de complicaciones postoperatorias fue del 33,1 y el 18,7%, respectivamente, y prevalecieron las de tipo infeccioso. Conclusiones. Aunque la edad no debe ser un factor excluyente para la CL, la tasa de conversión, las complicaciones postoperatorias y la estancia hospitalaria son mayores en estos pacientes que en el resto de la población. Son características la mayor morbilidad por la enfermedad de base, y una evolución más larga del cuadro con hallazgos más frecuentes de colecistitis evolucionada, que complican el abordaje laparoscópico en estos pacientes (AU)
Introduction. The aim of this study was to assess the influence of age in laparoscopic cholecystectomy (LC) for the treatment of acute cholecystitis by determining the benefits and postoperative complications in patients older than 65 years. Material and method. Between January 2003 and March 2006, we performed 134 urgent LC for acute cholecystitis: 58 patients older than 65 years (group 1) were compared with 76 patients younger than 65 years (group 2). Preoperative, intraoperative and postoperative variables were compared between groups 1 and 2. ASA score was used in the preoperative anesthetic evaluation. Results. A total of 31.2% of patients in group 1 had high surgical risk (24% ASA III and 9.2% ASA IV). The conversion rate was 24.1% in group 1 versus 11.3% in group 2 (p = 0.04), due to difficulty in surgical dissection and advanced cholecystitis. The mean length of postoperative hospital stay was 4.7 ± 3.2 days in group 1 versus 3.3 ± 2.4 days in group 2 (p = 0.001). The overall rate of postoperative complications was 33.1% and 18.7% respectively, with a predominance of infectious complications. Conclusions. Although age should not be an exclusion factor for LC, the conversion rate, postoperative complications and length of hospital stay are increased in the elderly. Higher morbidity due to the underlying disease and longer disease duration with more advanced cholecystitis complicate the laparoscopic approach in these patients (AU)
