Laparoscopic versus open cholecystectomy - A Prospective comparative studyin the elderly with acute cholecystitis

The aim of this prospective comparative study was to determine the feasibil ity and the efficacy of laparoscopic cholecystectomy for acute cholecystiti s in patients older than 75 years of age and to compare the results with th ose of open cholecystectomy. From January 1992 to December 1999. 139 patien ts older than 75 years of age underwent cholecystectomy for acute cholecyst itis. The two groups of patients with cholecystolithiasis included 50 patie nts who underwent laparoscopic cholecystectomy (group 1) and 89 patients wh o underwent open cholecystectomy (group 2). Group I consisted of 30 women a nd 20 men., with a mean age of 81.9 years (range. 75-98). Group 2 consisted of 51 women and 38 men, with a mean age of 81.9 years (range, 75-93). Ther e was no difference in the American Society of Anesthesiologists classifica tion in both groups. The length of the surgery (103.3 vs. 149.7 minutes), p ostoperative length of stay (7.7 vs. 12.7 days), and inpatient rehabilitati on (15 vs. 42 patients) were significantly shorter in group I than in group 2. The postoperative morbidity rate was not different between the groups. There was no mortality in group 1, but four patients died in group 2 (P = 0 .29). The conversion rate was 32% (n = 16) in group 1. In summary, laparosc opic cholecystectomy in elderly patients with acute cholecystitis is safe a nd effective. Laparoscopic cholecystectomy in elderly patients restores the m to the best possible quality of life with the lowest cost to them physiol ogically.