LAPAROSCOPIC CHOLECYSTECTOMY IN THE ELDERLY

Background: Advanced age with its concomitant comorbid conditions may be associated with increased postoperative laparoscsopic cholecystecto my (LC) complications and more frequent conversion to open cholecystec tomy (OC). The purpose of this study was to evaluate the outcome of LC in patients age 65 and older. Methods: Ninety consecutive patients we re studied age 65 and older, of whom 39 (43%) were males and 51 (57%) were females, mean age 74 years (range 65-98), with 20 patients (22%) greater than or equal to 80. Indications for surgery included biliary colic 55 (61%), acute cholecystitis 22 (24%), pancreatitis 10 (11%), a nd cholangitis 3 (4%). Seventeen patients (19%) had preoperative ERCP, 12 of which were normal; five had sphincterotomy with stone extractio n. Comorbid conditions included hypertension (44%), CAD (17%), cardiac arrhythmias (18), CHF (9%), and COPD (7%). Results: Operative time-me an 1 h 51 min +/- SD 43 min. Conversion to OC-three patients (3%). Len gth of stay-mean 5 days (range 1-26). Mortality-two patients (2%) >80 years old, one patient with septicemia and multiorgan failure whose co morbid diseases included CAD, C.F., COPPED, and elevated BP, one patie nt with MI postsurgery, morbid diseases included DM and CAD. Complicat ions-five patients (5%): bile leak from cystic duct stump (one), posts urgery MI (two), incarcerated incisional hernia (one), septicemia (one ). Conclusion: Morbidity rates for LC in the elderly population are no t different from that reported for patients less than 65 years of age. (5% vs 6%, Fried et al., Surg Clin North Am 1994;74 [2]: 375-387). Ou r 2% mortality rate is statistically different from previously reporte d in a series of patients of all ages (0.6%, Fried et al.). The 3% rat e of conversion to OC in this older population is not significantly di fferent from the patients in Fried et al. series (4%).