Surgical outcomes of laparoscopic cholecystectomy for acute cholecystitis in elderly patients

Relevance. The prevalence of cholelithiasis increases with age and reaches 25-30% in elderly and senile patients [1]. The "golden standard" of surgical intervention for acute cholecystitis, by right, is considered to be video-laparoscopic cholecystectomy, but with severe concomitant pathology, video-laparoscopic cholecystectomy is limited. Even with the "open" cholecystectomy in patients older than 60 years, lethality is 5-10 times higher than in young people [4]. In connection with this, an alternative method of treatment of OX in patients of older age groups was proposed - thermal mucoclasiа of the gallbladder. Aim. To carry out complex analysis of the results of laboratory and ultrasound methods of clinical examination in elderly patients with acute cholecystitis (AC) depending on two main types of surgical treatment: video laparoscopic cholecystectomia or thermal mucoclasia of a gall bladder. Materials and methods. The results of the red and white blood counts, the assessment of biochemical blood parameters, immune markers and the outcomes of ultrasound examination of the gall bladder before operation and after different periods following this treatment were analyzed in elderly patients who were admitted urgently to the surgical units of the Kursk city hospitals. Results and its discussion. In patients who underwent traditional cholecystostomy with the thermal mucoclasia lower values of erythrocytes, hemoglobin and general protein levels were detected demonstrating the presence of anemia. In this group the secondary immunodeficiency with alterations of the T-cell immunity was noted. These changes are most probably related to aging since the average age of these patients was about 10 years more than in the VLHE group. Patients who were operated by VLHE were admitted to hospitals with more pronounced changes of biochemical blood parameters, i.e. with higher levels of bilirubin, ACT, ALT and amylase. Conclusions. The results of the present study can be used for the choice of the surgical operation and for the pre-operatory treatment of elderly patients with acute cholecystitis.

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Analysis of the surgical treatment results for an acute cholecystitis in the senile and elderly patients, depending on term of the operative intervention performance

Klinicheskaia khirurgiia ◽

10.26779/2522-1396.2020.9-10.09 ◽

2020 ◽

Vol 87 (9-10) ◽

pp. 9-13

Author(s):

S. M. Zavgorodniy ◽

M. B. Danylyuk ◽

A. І. Rylov ◽

M. A. Kubrak ◽

N. O. Yareshko ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Surgical Treatment ◽

Elderly Patients ◽

Acute Cholecystitis ◽

Average Duration ◽

Operative Intervention ◽

Postoperative Treatment ◽

Biliary Duct ◽

Preoperative Preparation ◽

Abdominal Drainage

Objective. To estimate the results of surgical treatment in the senile and elderly patients for an acute cholecystitis on background of biliary calculous disease in urgent abdominal surgery, depending on term of performance of operative intervention. Materials and methods. In the investigation there were included 89 patients, ageing 60-89 yrs old with diagnosis: an acute cholecystitis on background of biliary calculous disease. Median age of the patients have constituted (69.66 ± 7.30) yrs old. Results. All the patients were operated in urgent order, average duration of preoperative period was 20.00 (7.00; 27.00) h. Laparoscopic cholecystectomy with abdominal drainage was performed in 70 (78.7%) patients; laparotomy, cholecystectomy with abdominal drainage- in 14 (15.7%); laparotomy, cholecystectomy with drainage of common biliary duct - in 5 (5.6%). In 3 (4.3%) patients while performing of laparoscopic cholecystectomy the necessity have emerged for conversion due to hemorrhage from the gallbladder bed. Preoperative preparation in the senile and elderly patients during more than 24 h have led to significant improvement of their general state, comparing with those, who were operated in terms up to 24 h from the moment of admittance to hospital (U-criterion = 749.50; p = 0.0286). As well, in accordance to data, concerning postoperative period analysis, there was noted significant improvement of the patients’ state, preoperative preparation of whom lasted more than 24 h, comparing with the patients, preoperative preparation of whom lasted lesser than 24 h (U-criterion = 491.00; p < 0.0001). Average duration of stationary stay have differed in this two Groups (U-criterion = 919.00; p = 0.3984). Conclusion. The surgery deferred performance for an acute cholecystitis in the senile and elderly patients permits to improve the results of postoperative treatment and to reduce the frequency of postoperative complications significantly.

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Analysis of bailout procedure in laparoscopic cholecystectomy for acute cholecystitis

10.21203/rs.3.rs-257094/v1 ◽

2021 ◽

Author(s):

Shigeyuki Nagata ◽

Seiichiro Kai ◽

Daisuke Korenaga ◽

Masaki Mori ◽

Satoshi Toyota ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Acute Cholecystitis ◽

Subgroup Analysis ◽

Surgical Outcomes ◽

Japanese Patients ◽

Open Group ◽

Standard Group ◽

Open Conversion ◽

Reactive Protein ◽

Subtotal Cholecystectomy

Abstract Background: The Tokyo Guidelines 2018 recommend a bailout procedure consisting of fundus-first cholecystectomy, subtotal cholecystectomy, or open conversion to prevent serious complications in cases of difficult laparoscopic cholecystectomy (LC).Methods: The hospital records of patients with acute cholecystitis who underwent LC from October 2014 to April 2019 were retrospectively analyzed. The clinical data were compared between the standard and bailout groups. A subgroup analysis was performed to compare the fundus-first and subtotal cholecystectomy techniques versus open conversion.Results: In total, 160 of 416 Japanese patients who underwent LC were diagnosed with acute cholecystitis. Standard LC was performed in 125 (78%) patients, and a bailout procedure was performed in 35 (22%). The duration from onset to surgery was significantly longer (P = 0.04) and the C-reactive protein (CRP) concentration was significantly higher (P = 0.001) in the bailout than standard group. The surgical outcomes were worse in the bailout group. In the multivariate analysis, a high CRP concentration at diagnosis was an independent predictor of bailout (P = 0.004). In the subgroup analysis, the open group had a significantly longer duration from onset to surgery (P = 0.04) and a significantly higher incidence of preoperative drainage (P = 0.002). With respect to surgical outcomes, the open group had significantly greater blood loss (P = 0.02) and longer hospital stays (P = 0.002). Conclusion: A high CRP concentration is a risk factor for a bailout procedure. Early LC should be performed for patients with acute cholecystitis and a high CRP concentration.

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LAPAROSCOPY REPRESENTS THE GOLD STANDARD FOR ACUTE CHOLECYSTITIS EVEN IN ELDERLY PATIENTS

Journal of Surgical Sciences ◽

10.33695/jss.v2i2.107 ◽

2015 ◽

Vol 2 (2) ◽

pp. 59-62

Author(s):

I. Negoi ◽

I. Tănase ◽

B. Stoica ◽

S. Păun ◽

S. Hostiuc ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Elderly Patients ◽

Hospital Stay ◽

Acute Cholecystitis ◽

Gold Standard ◽

Open Cholecystectomy ◽

Laparoscopic Approach ◽

Length Of Hospital Stay ◽

Morbidity Rate ◽

Open Approach

Nowadays the laparoscopic approach represents the gold standard for acute cholecystitis, but we are facing little evidence regarding the elderly patients. The purpose of this study is to define the benefits in terms of early outcome for laparoscopic cholecystectomy in patients over 70 years old and to compare them with the open cholecystectomy through a retrospective study of patients that underwent a cholecystectomy during 12 months in the Emergency Hospital of Bucharest, Romania. Out of 49 patients, 20 had a laparoscopic cholecystectomy (LC) and 29 an open approach (OC). The mean age was 74,6 ± 4,2 (LC) vs. 77,2 ± 5,4 (OC) (P>0.05). There were 7 (33,3%) (LC) vs. 2 (7,1%) (OC) catarrhal cholecystitis, 13 (62%) (LC) vs. 9 (32,1%) (OC) phlegmonous cholecystitis, and 1 (4,8%) (LC) vs. 17 (60,7%) (OC) gangrenous cholecystitis (P=0.001, Cramer’s V=0,590). The median operative time was 90 (LC) vs. 60 (OC) minutes (P=0.001). There were no differences regarding the ASA risk scale (P=0,253). The median number of days to resume the diet was 3 (LC) vs. 4 (OC) (P=0.009). The median length of hospital stay was 72 hours (LC) vs. 120 hours (OC) (P=0.011). One patient died in the OC group and none in the LC group.To conclude, the laparoscopic approach in acute cholecystitis of elderly patients is safe. It is followed by a lower morbidity rate, a shorter length of hospital stay and by a more rapid return to normal activities.

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