Early laparoscopic cholecystectomy for acute gallbladder disease in Chinese elderly

Abstract

Background/aims: Evidence now strongly supports that early laparoscopic cholecystectomy (ELC) is the treatment of choice for acute gallbladder disease. However, the optimal time for managing acute gallbladder disease in elderly people is still controversial. The purpose of this study was to evaluate the outcome of ELC in patients aged 65 years old and older.

Methodology: We performed a retrospective case study review of patients undergoing ELC in a single institution between January 2005 and December 2008.

Results: A total of 4048 patients were analyzed: 737 patients were older than 65 years old and 3311 younger. In total, 18% of the elderly patients and 3% of the younger patients had American Society of Anesthesiologists (ASA) score III and IV, respectively (p < 0.001). Co-morbidity rates were significantly higher in the elderly group (61.5% vs. 20.7%, p < 0.001). There was no difference in operative time, intraoperative complications, hospital stay and mortality between the two groups, except that the rate of conversion to open cholecystectomy (OC) and postoperative complications were significantly higher in elderly patients.

Conclusion: Even though elderly patients are more likely to present with several co-morbidities in advanced stages, ELC for elderly patients with acute gallbladder disease is safe and effective, and should be regarded as the standard of care.