LAPAROSCOPIC CHOLECYSTECTOMY IN THE GERIATRIC POPULATION

Although the role of laparoscopic cholecystectomy (LC) as a safe and c ost effective procedure has been ascertained, its role in the geriatri c population, the majority of whom present with coexistent diseases, h as yet to be defined. We retrospectively reviewed outcome parameters o f 144 consecutive patients over age 65 undergoing LC, for both acute c holecystitis and symptomatic cholelithiasis. These results were compar ed with 72 patients having open cholecystectomy (OC) during the same t ime period and in the year preceding the introduction of LC. Groups we re well matched with respect to age, age distribution, indication for surgery, and underlying comorbid illnesses. Of those with symptomatic cholelithiasis, LC did not prolong operative time when compared with O C, but resulted in significantly earlier discharge (1.8 +/- 2.9 vs. 6. 7 +/- 5.7 days (P < 0.001)) with comparable hospital costs and with no increase in postoperative complications. With respect to acute cholec ystitis, LC significantly prolonged operative time (105.8 +/- 40.8 vs. 78.1 +/- 28.5 minutes (P < 0.05)), but when successful, significantly reduced postoperative stay (4.2 +/- 3.8 vs. 7.5 +/- 2.3 days (P < 0.0 5)). There was no increase in postoperative complications in those hav ing LC, and hospital costs were comparable with OC. Seven patients wer e converted from LC to OC; 4 of these (16%) were for acute cholecystit is versus a 2.5 per cent incidence of conversion for symptomatic chole lithiasis, and these resulted in prolonged hospital stays and costs. T here was no incidence of hypotension/hypercarbia, despite a 64 per cen t incidence of underlying cardiopulmonary diseases in those having LC. There was a 14 per cent incidence of cardiopulmonary complications in those having LC in contrast to a 43 per cent incidence in OC. LC in t he geriatric population is a safe procedure for symptomatic cholelithi asis. The procedure should be undertaken with caution in those with ac ute cholecystitis with a low threshold for either early conversion or primary OC. Finally, our results suggest that extensive hemodynamic mo nitoring is not indicated.