Laparoscopic cholecystectomy in the geriatric population

Although the role of laparoscopic cholecystectomy (LC) as a safe and cost effective procedure has been ascertained, its role in the geriatric population, the majority of whom present with coexistent diseases, has yet to be defined. We retrospectively reviewed outcome parameters of 144 consecutive patients over age 65 undergoing LC, for both acute cholecystitis and symptomatic cholelithiasis. These results were compared with 72 patients having open cholecystectomy (OC) during the same time period and in the year preceding the introduction of LC. Groups were well matched with respect to age, age distribution, indication for surgery, and underlying comorbid illnesses. Of those with symptomatic cholelithiasis, LC did not prolong operative time when compared with OC, but resulted in significantly earlier discharge (1.8 ± 2.9 vs. 6.7 ± 5.7 days (P < 0.001)) with comparable hospital costs and with no increase in postoperative complications. With respect to acute cholecystitis, LC significantly prolonged operative time (105.8 ± 40.8 vs. 78.1 ± 28.5 minutes (P < 0.05)), but when successful, significantly reduced postoperative stay (4.2 ± 3.8 vs. 7.5 ± 2.3 days (P < 0.05)). There was no increase in postoperative complications in those having LC, and hospital costs were comparable with OC. Seven patients were converted from LC to OC; 4 of these (16%) were for acute cholecystitis versus a 2.5 per cent incidence of conversion for symptomatic cholelithiasis, and these resulted in prolonged hospital stays and costs. There was no incidence of hypotension/hypercarbia, despite a 64 per cent incidence of underlying cardiopulmonary diseases in those having LC. There was a 14 per cent incidence of cardiopulmonary complications in those having LC in contrast to a 43 per cent incidence in OC. LC in the geriatric population is a safe procedure for symptomatic cholelithiasis. The procedure should be undertaken with caution in those with acute cholecystitis with a low threshold for either early conversion or primary OC. Finally, our results suggest that extensive hemodynamic monitoring is not indicated.