scholarly journals 398 Outcome of Laparoscopic Cholecystectomy in Patients Over 80 Years Old

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
D Gumaa ◽  
A Hunt ◽  
D Karunaratne ◽  
S Shresta ◽  
B Al-Robaie
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gallstone Disease ◽  
District General Hospital ◽  
The Elderly ◽  
Biliary Colic ◽  
Old Patients ◽  
Medical Background ◽  
Admission Data ◽  
Emergency Group ◽  
Elective Group

Abstract Background Gallstone disease is a common cause of morbidity in old patients. Conservative treatment is usually the first line of treatment due to concerns about the risk of surgery. In our study we are trying to assess the outcome of laparoscopic cholecystectomy in patients over 80 years old. Method Retrospective cohort study done in a large district general hospital where good number of laparoscopic cholecystectomy is done every year. Main outcome is Mortality, return to theatre and post op ITU admission. Data collected from patients records. Results 74 patients in total were operated on. 14 operations were done as emergency (during the same inpatient admission). Indication for surgery varied between cholecystitis, pancreatitis and biliary colic. But the main indication in the emergency group was acute cholecystitis. 55 % of the patients had significant medical background with ASA 3. 30 days mortality was 0 in both emergency and elective groups. 2 patients required ITU admission post op, mainly for premorbid status, and both were in the emergency group. There was only one return to theatre in the emergency group for washout. 90% of the elective group patients were done as day case with no post op complications. Conclusions Laparoscopic cholecystectomy is safe operation to be done in the elderly population. ITU admission is mainly because of the patient’s co-morbidities so patients should be selected carefully and have proper pre op assessment.

TP6.1.9 Prolonged post-operative stay following emergency and elective laparoscopic cholecystectomies and its contributing factors

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
James Lucocq ◽  
Ganesh Radhakishnan ◽  
John Scollay ◽  
Pradeep Patil
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gallstone Disease ◽  
Contributing Factors ◽  
Surgical Decision ◽  
Logistic Regression Models ◽  
Factors Associated ◽  
Surgical Units ◽  
Emergency Group ◽  
Elective Group ◽  
Heterogenous Population

Abstract Aims Patients who undergo laparoscopic cholecystectomy (LC) for gallstone disease are a heterogenous population with many variables involved in their management. The aim was to identify the proportion of patients who have a prolonged post-operative stay (PPS; >3days) following elective and emergency LC and the variables that most contribute to PPS. Methods We retrospectively collected data for all patients who underwent an elective and emergency LC across three surgical units from 2015 to 2020. Rates of PPS were compared between elective and emergency groups and variables associated with PPS were identified using multivariate logistic regression models. Results 2769 patients were included in the study (median age, 53years(range, 13-92); M:F,1:2.7; emergency:elective,1:3.6) The rate of PPS was higher in the emergency versus elective group (25.1% versus 6.6%; p<0.0001). Pain was one of the major causes in both groups. In the elective group, factors associated with PPS included cholecystitis (OR,1.96; p=0.008), previous gallstone related admissions (OR,1.48; p=0.008), pre-operative ERCP (OR,3.58;p<0.0001), ASA (OR,1.82; p=0.001) and age (years) (OR,1.03;p=0.001). In the emergency group, factors associated with PPS include cholecystitis (OR,5.3;p<0.0001), ASA (OR,1.96; p = 0.01) and pre-operative ERCP (OR,4.44;p=0.001). Conclusions The rate of PPS following laparoscopic cholecystectomy is significant, particularly in the emergency group. Although the possibility of PPS cannot be avoided, patient information regarding the possibility of PPS is important, particularly for those at risk. The risk factors for PPS should be used to guide surgical decision making and should be followed by targeted management of these patients including optimised pain relief.

scholarly journals Acute Laparoscopic Cholecystectomy: Delays in Acute Surgery and Cost Analysis of Aproposed New Service

2011 ◽  
Vol 93 (7) ◽  
pp. 261-265
Author(s):  
AJ Cockbain ◽  
AL Young ◽  
E McGinnes ◽  
GJ Toogood
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Meta Analysis ◽  
Gallstone Disease ◽  
Cochrane Review ◽  
Length Of Hospital Stay ◽  
Biliary Colic ◽  
Complication Rates ◽  
Acute Surgery ◽  
Symptomatic Gallstone Disease

Acute laparoscopic cholecystectomy (ALC) is widely considered the most appropriate management for patients presenting with acute cholecystitis as supported by a recent meta-analysis and Cochrane review. Although the benefit of ALC is less clear in patients with biliary colic, few would disagree that earlier cholecystectomy is preferable for most patients with symptomatic gallstone disease. ALC has similar complication rates to elective laparoscopic cholecystectomy (ELC) and a reduced total length of hospital stay. Recurrent symptoms from untreated gallstone disease are common, with the risk of developing more severe complications such as acute cholecystitis, acute pancreatitis or cholangitis while waiting for an operation. It has been reported that patients awaiting ELC after an acute admission have significantly more general practitioner (GP) attendances than those who receive ALC, that they have an average of one emergency department attendance for symptom recurrence and that one in six requires hospital admission due to the severity of recurrent symptoms.

scholarly journals P-EGS14 From Gallstone Disease to Cholecystectomy: An audit looking at the waiting times for cholecystectomy in a small District General Hospital

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Jacob Mewse ◽  
Virginia Ledda ◽  
Ellie Connor ◽  
Peter Frank Mason
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Waiting Time ◽  
Negative Impact ◽  
Elective Surgery ◽  
Waiting Times ◽  
Gallstone Disease ◽  
Gastrointestinal Surgery ◽  
Emergency Operation ◽  
Biliary Colic ◽  
Emergency General Surgery

Abstract Background Gallstone-related disease accounts for a third of emergency general surgery admissions and referrals. The average waiting time for acute gallstone presentations to laparoscopic cholecystectomy is about 7 days in England. This audit aims to identify emergency admissions and compare local management to the Association of Upper Gastrointestinal Surgery of Great Britain and Ireland (AUGIS) guidelines standards with a focus on waiting times for laparoscopic cholecystectomy (LC). Where AUGIS standards were not met, number of re-admissions and complications were identified. A cost analysis was also completed looking at the overall costs of delayed treatment. Methods We identified all patients admitted as an emergency between September 2019 and September 2020 with gallstone-related pathology. Patients not referred to the surgical team, with negative Ultrasound Scans (USS) or known HPB malignancy were excluded. The patients were divided into a pre- COVID -19 and during COVID-19 category (respectively before and after March 2020), to identify whether the cancellation to non- urgent elective surgery (due to COVID-19) had caused further delays or complications. Each patient’s management was compared to AUGIS guidelines depending on their diagnosis at presentation (biliary colic, cholecystitis, cholangitis, gallstone-related pancreatitis), focusing on the timing between presentation and LC. Results A total of 99 patients were identified. Of the patients presenting with biliary colic (n = 9 pre-COVID, n = 5 during COVID), none underwent LC within 72 hours from presentation as recommended by AUGIS. Of the patients presenting with cholecystitis (n = 20 pre-COVID and n = 16 during COVID), none had LC within the recommended 72 hours. 5 patients in each COVID group had LC, with a significantly longer waiting time compared to the pre-COVID group. Re-admissions and complications were similar for the cholecystitis patients in both COVID groups. In the gallstone-related pancreatitis group, only 1 patient underwent LC within the recommended 2 weeks. Conclusions This audit showed that locally we are failing to meet AUGIS guidelines for LC within 72 hrs, 2 weeks or 6 weeks both pre and during COVID. This has caused re-admissions of patients with cholecystitis, pancreatitis and perforated gallbladders. Factors that cause delay are limited access to USS, limited staff and theatre availability. To improve outcomes, it is necessary to implement a hot gallbladder service with dedicated theatre slots. A change in the overall perception of LC is also needed: this is should be considered an emergency operation as its delay has a significant negative impact on patients’ outcomes.

scholarly journals Primary Choledocholithiasis 15 Years Postcholecystectomy

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Michael Simon ◽  
Irfan Nazir Hassan ◽  
Dhanasekaran Ramasamy ◽  
David Wilson
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Standard Treatment ◽  
Case Reports ◽  
Gallstone Disease ◽  
The Elderly ◽  
Western Society ◽  
Bile Duct Stones ◽  
Symptomatic Gallstones

Gallstone disease is extremely prevalent in the western society with laparoscopic cholecystectomy (LC) being the standard treatment for patients with symptomatic gallstones. The prevalence of common bile duct (CBD) stones with concomitant gallstones increases with age from 8–15% in patients <60 years of age and up to 60% in the elderly. There have been only a few case reports of postcholecystectomy bile duct stones occurring more than 10 years following surgery in the literature. Most of these reports describe the presence of stones within the gallbladder/cystic duct remnant or secondary to migrating surgical clips.

scholarly journals A laparoszkópia szerepe a 80 évesnél idősebb betegek epekövességének megoldásában

2016 ◽  
Vol 157 (5) ◽  
pp. 185-190 ◽  
Author(s):  
Tímea Kakucs ◽  
László Harsányi ◽  
Péter Kupcsulik ◽  
Péter Lukovich
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Elective Surgery ◽  
Length Of Hospital Stay ◽  
Common Bile Duct Stones ◽  
Age Group ◽  
Type Conversion ◽  
Emergency Group ◽  
Elective Group ◽  
Elective Cholecystectomy

Introduction: The incidence of cholelithiasis increases with age, however, there is still little data about the outcomes of cholecystectomy in patients with age of 80 and above. Population ageing presents tremenduous challenges for surgeons. Aim: The aim of the authors was to compare emergency and elective cholecystectomies performed in these elderly patients. Method: This retrospective study was based on the analysis of operation type, conversion rate, complications, mortality, length of hospital stay of all patients over 80 who underwent cholecystectomy in the last 6 years at the 1st Department of Surgery, Semmelweis University. Results: 69 elective and 51emergency operations were performed. In the emergency group pancreatitis was found in 9.8%, liver abscess in 14%, and common bile duct stones in 27% of the patients on admission. Laparoscopic cholecystectomy could be performed in 84% of patients in the elective group, while in 17.7% of patients in the emergency group. The length of stay at the intensive care unit was 9.1 and 1 days, while the total length of hospital stay was 12 and 3.6 days for the elective and emergency groups, respectively. In the emergency group mortality was 20% and reoperation was performed in 16% of patients, while at the elective group none of these occured. Conclusion: Laparoscopic cholecystectomy is safe as elective surgery for patients with age of 80 and above. For this reason the authors recommend elective cholecystectomy in this age group. Orv. Hetil., 2016, 157(5), 185–190.

Safe and uncomplicated inguinal hernia surgery in the elderly – message from anesthesiologists to general surgeons

2017 ◽  
Vol 89 (2) ◽  
pp. 5-10 ◽  
Author(s):  
Tomasz Chlebny ◽  
Piotr Zelga ◽  
Mateusz Pryt ◽  
Marta Zelga ◽  
Adam Dziki
Keyword(s):  
Inguinal Hernia ◽  
The Elderly ◽  
Careful Examination ◽  
Medical Complications ◽  
Hernia Surgery ◽  
Inguinal Hernia Surgery ◽  
Emergency Group ◽  
Elective Setting ◽  
Elective Group ◽  
Surgery In The Elderly

Introduction Elderly patients are often discouraged from surgery due to the risk of complications that increases with age. Aim We wanted to assess mortality, morbidity, and complications in patients older than 75 years who underwent elective or emergency inguinal hernia repair in a single center. Methods All patients older than 75 years who were operated on because of inguinal hernia in the Department of General and Colorectal Surgery, Medical University of Lodz between 2003 and 2015 were analyzed. Detailed information was collected with regard to patient demographics, mode of admission, comorbidities, type of intervention, applied anesthesia, and 30-day outcomes. Postoperative outcomes included medical and surgical complications, readmissions, and survival status. Results One hundred thirty-two patients older than 75 years were operated on for inguinal hernia, 16 (12.1%) in an emergency setting and 116 (87.9%) in an elective setting. Eighteen patients (13.6%) developed complications, 8 (50%) in the emergency group, and 10 (8.6%) in the elective group. In the emergency group, severe medical complications (Clavien-Dindo 4) were frequent, whereas in the elective group, severity of surgical and medical complications was not significantly different (Clavien-Dindo median score 2, p=0.6084), and these complications were classified as mild (Clavien-Dindo 1-2). One death occurred in the emergency group. Conclusion Inguinal hernia surgery in the elderly may be safe and effective in an elective setting and if regional anesthesia is used. Careful examination of patients before surgery and identification of potential risk factors associated with co-existing diseases are vital for reducing the risk of complications. Key point: Hernia surgery in patients older than 65 years is a low-risk intervention, if carried out in an elective setting.

Gallstone disease

2018 ◽  
pp. 401-414
Author(s):  
Abdullah Jibawi ◽  
Mohamed Baguneid ◽  
Arnab Bhowmick
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Obstructive Jaundice ◽  
Gallstone Disease ◽  
Acute Cholangitis ◽  
Biliary Colic ◽  
Ultrasound Scan ◽  
Bile Duct Stones ◽  
Clinical Presentations ◽  
Laparoscopic Bile Duct Exploration

Gallstone disease is common with clinical presentations including biliary colic, cholecystitis, and obstructive jaundice. Acute cholangitis and pancreatitis are other complications. Ultrasound scan and MRCP as well as endoscopic ultrasound are investigation modalities. Medical treatment of gallstones with ursodeoxycholic acid is discussed as well as laparoscopic cholecystectomy with its risks and benefits. The prevalence of bile duct stones is around 10–20%. Strategies for investigation and management are discussed, including ERCP and laparoscopic bile duct exploration.

scholarly journals O-EGS02 Effective use of afternoon Day Case Theatre Lists for Emergency Laparoscopic Cholecystectomy on Emergency Surgery Ambulatory Care (ESAC) Pathway

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Rui Wei ◽  
Mishal Shahid ◽  
Jessica Barton ◽  
Lian Williams ◽  
Marianne Hollyman
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Admission ◽  
Ambulatory Care ◽  
Emergency Surgery ◽  
Gallstone Disease ◽  
Low Flow ◽  
Biliary Colic ◽  
Day Case ◽  
Hospital Admission Rate ◽  
Symptomatic Gallstones

Abstract Background Gallstone disease is a common entity and affects up to 10-15% of the European population. The majority of these cases are asymptomatic but approximately 20% will develop complications such as severe biliary colic, cholecystitis, choledocholithiasis and pancreatitis. Early cholecystectomy in patients suffering from symptomatic gallstones can improve post-operative outcomes, avoid re-attendance and reduce overall length of hospital stay. We describe how two afternoon day case theatre lists were successfully utilised to prevent surgical admissions by enabling laparoscopic cholecystectomy on an urgent basis. Methods A sustainable pathway for symptomatic gallstones was introduced to Emergency Surgery Ambulatory Care (ESAC). Patients presenting with acute symptoms, well enough for ambulatory care, were referred to ESAC for diagnosis and management. Patients fit for surgery underwent pre-operative assessment before being operated on one of two weekly afternoon lists. A standardised, evidence-based approach was used for all laparoscopic cholecystectomies to ensure homogeneity of technique and patient care. This included pre-incision local anaesthetic, low flow and pressures intra-operatively, adequate analgesia to-take-home, and follow-up telephone consultation at 48hrs. Prospective data collection began in 2019 looking at hospital admission rate and 30-day re-presentation. Results Analysis was performed on data collected from September 2019 to July 2021. 151 patients had laparoscopic cholecystectomies, 107 were female and 44 male. Age range was 18-83 (median age 49) and median time to operation was 3 days. Overall, the spectrum of gallstone disease was 81 biliary colic, 44 cholecystitis, 20 pancreatitis and 6 choledocholithiasis. 18 patients were admitted post-operatively with length of stay ranging 1-6 days (median 1.5 days). 17 patients re-presented within 30 days, mainly for abdominal or pleuritic chest pain, although one patient required ERCP for CBD stones and another had pancreatitis. Conclusions Emergency surgery for symptomatic gallstone disease can be performed successfully on a day case basis. At our centre, the rate of post-operative admission was 12% and 30-day re-presentation was 11%. Standardisation of referrals, assessment and operative technique can achieve excellent outcomes with low rates of hospital admission and post-operative complications.

The quality of life in patients after laparoscopic cholecystectomy due to gallstone disease - evaluation of long-term postoperative results

2021 ◽  
Vol 93 (SUPLEMENT) ◽  
pp. 1-5
Author(s):  
Tomasz Gach ◽  
Paweł Bogacki ◽  
Beata Markowska ◽  
Joanna Bonior ◽  
Małgorzata Paplaczyk ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Laparoscopic Cholecystectomy ◽  
Gallstone Disease ◽  
Biliary Colic ◽  
Study Group ◽  
Post Surgery ◽  
Asymptomatic Patients ◽  
Symptomatic Gallstone Disease ◽  
The Impact

Introduction: Currently, the standard treatment of gallstone disease is laparoscopic cholecystectomy. Considering its availability, reduction of postoperative pain and shortened stay in the hospital, a constant upward trend in the number of such procedures is observed. However, about one third of patients undergoing such treatment report pain and dyspeptic disorders following the surgery. The assessment of the quality of life of patients undergoing laparoscopic cholecystectomy, based on standardized questionnaires, should be one of the elements allowing for the assessment of the impact of the applied treatment on patients' lives. Aim: The aim of this retrospective study is to evaluate the impact of laparoscopic cholecystectomy on the quality of life of patients operated in one center. Material and methods: The study has been carried out retrospectively with the use of a GIQLI questionnaire completed online by the patients 6 months after undergoing laparoscopic cholecystectomy. The study included patients over 18 years of age who have not experienced any complications within the perioperative period and did not require open surgery. The study group has been divided into two subgroups depending on the presence of symptoms of acute gallstone disease in the pre-operative period. Results: The study group consisted of 205 patients (53 men, 152 women, aged 19 to 87, with an average of 54.3). The subgroup with an asymptomatic gallstone disease (dyspeptic disorders, without biliary colic) consisted of 47 patients (18 men, 29 women, aged 19-87). Symptomatic gallstone disease occurred in 158 people (35 men, 123 women aged 22 to 81). There have been certain statistically significant differences in the post-operative health condition between the group of patients with symptoms of gallstone disease and the asymptomatic patients. 94.3% of symptomatic patients concluded that their condition has improved and 5.7% that it remained unchanged. Among asymptomatic patients, only 53.2% of patients stated that they felt better post-surgery, 44.7% reported no changes (p <0.001). There have been no significant differences in the overall QIQLI scores between these subgroups, although symptomatic patients assessed their social functioning better (8.9 ± 1.5 vs 8.11 ± 2.08, p = 0.004). There have been certain differences between men and women in the assessment of the quality of life in the context of the presence of key symptoms (M: 28.87 ± 4.23, F: 26.77 ± 5.0, p = 0.007) Conclusions: The patients with a symptomatic gallstone disease report they feel better after laparoscopic cholecystectomy as compared to the group of asymptomatic patients. The overall QOL score measured by the GIQLI form does not depend on the presence of symptoms in the preoperative period. Men benefited more from surgery as regards key symptoms.

scholarly journals Role of laparoscopic cholecystectomy in Geriatric patients (>60 years of age).

2020 ◽  
Vol 27 (01) ◽  
pp. 62-67
Author(s):  
Irfan Haider Abdi ◽  
Rehana Firdos ◽  
Qambar Ali Laghari ◽  
Mujeeb ur Rahman Sahito ◽  
Naimatullah Kalhoro ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Elderly Patients ◽  
Geriatric Patients ◽  
Open Cholecystectomy ◽  
Gallstone Disease ◽  
Gall Stone ◽  
Young Patients ◽  
Age Group ◽  
Old Patients ◽  
The Mean

Objectives: In elderly patients, recent research has also questioned the effectiveness of this surgery. The objective of our study is to evaluate the safety and applicability of laparoscopic cholecsytectomy in geriatric patients (over 60 year of age) for the symptomatic cholelothiasis. Study Design: Prospective and observational study. Setting: Different surgical wards at LUHMS Jamshoro / Hyderabad who undergone for laparoscopic cholecystectomy. Period: One year from 01-03-2017 to 28-02-2018. Material & Methods: 100 patients of 60 years of age and above having gall stone disease. All elderly patients of cholelithiasis (over 60 years) presenting with symptoms of gallstone disease will be included in this study irrespective of their sex. Results:  A total of 100 patients were included in this study. The minimum and maximum age range was 65 to 83 years. The mean age + SD, was 69.72 + 10.31 years. Most of the patients i.e. 60 (60%) were seen in the age group 60 to 65 years, 45(5.0%) patients were observed in the age group > 65 years. 52.0% (n=52) patients had co-morbidities followed by hypertension in 20 (20.0%), Diabetes Mellitus 15 (15.0%), COPD 7 (7.0%), Coronary artery disease 9 (9.0%) and cardiac arrhythmias 1 (1.0%) patient only. Most of the patients had duration of operation 90 to 120 minutes. The mean + SD operative time was 90.12 + 35.5 (60 to 250 minutes). Total operative complications were seen in 15(15.0%) patients who had injury of CBD in 3 patients and 4 patients had bleeding, failed to clip cystic duct 2 cases and 3 patients died. Nineteen (19.0%) elderly patients had postoperative complications and they were not undergone for laparoscopic surgery due to low intensity and occurrence. Overall mortality was seen 1(1.0%) because of acute myocardial infarction and it was occurred on the second day of the operation. Conclusion: Laparoscopic cholecystectomy is as safe and effective in old patients as compared to young patients with less complications, morbidity and mortality are very low and lesser than open cholecystectomy. The pain free post-operative period and early ambulation lead to saving of valuable working hours.

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