Miniinvasive surgical management of cholelithiasis for elderly and senile patients: a retrospective study.

The aim of the present study is to analyze outcomes after laparoscopic cholecystectomy (LC) and minilaparotomy cholecystectomy (MC) for gallstone disease and determine the algorithm of treatment for elderly and senile patients according to the age, severity of disease and comorbid conditions. This is a multicenter retrospective review of 906 elderly and senile patients who underwent LC or MC between January 1, 2002 and December 31, 2008. The patients were categorized into LC (444) and MC (462) groups. When preoperative examination data were not reliable, we performed abdominal wall lifting with the retractors to visualise abdominal cavity with laparoscope during minilaparotomy. There were statistically significant differences in mean operating time (82 and 60 minutes in LC and MC, respectively) (р<0.001), mean duration of usage of non-narcotic analgesics postoperatively in elderly patients (1.5 and 1.1 days in LC and MC, respectively) (р<0.001), intraoperative complications (11 LC and 2 MC cases) (p=0.02), postoperative complications in senile patients (36 LC and 22 MC cases) (p=0.039) and in mean hospital stay for elderly patients (1.7 and 1.3 days in LC and MC, respectively) (p=0.025). MC is an attractive alternative of LC, especially for elderly and senile patients, with their high incidence of acute cholecystitis. MC is effective, safe and optimal operative procedure. Especially, it is important for countries with lower economic capacity.