Laparoscopic cholecystectomy in the elderly: increased operative complications and conversions to laparotomy.

BACKGROUND

The incidence of gallstones increases with age and as the proportion of the population 65 years of age and older continues to grow, increased demand for laparoscopic cholecystectomy (LC) in the geriatric population is likely. LC has advantages over open cholecystectomy, but comparative evaluation of the procedure in elderly patients is lacking.

METHODS

We performed a two-year review of patients undergoing LC at our institution. Demographic information, diagnosis, operation performed, and operative complications were recorded. Patients were placed into two groups by age: 65 years and older, and those younger than 65 years of age. Primary outcome measures were complication rate and conversions to laparotomy.

RESULTS

A total of 315 patients underwent LC during the study period, of whom 59 (19%) were 65 years of age or older. The older age group experienced higher rates of conversion to an open procedure (22% vs. 2.7%, P<0.05), and operative complications (17% vs. 3.1%, P<0.05). Elderly patients also had longer operative times (108+/-55 minutes vs. 83<34 minutes, P<0.05). Acute (31% vs. 16%) and chronic (14% vs. 7.4%) cholecystitis were the operative diagnoses in a greater proportion of patients in the older age group, and elderly patients were more likely to have had prior upper abdominal surgery (8.5% vs. 1.6%, P<0.05).

CONCLUSION

LC in the geriatric population carries increased risk for conversion to laparotomy and operative complications compared to LC in younger patients. This is likely due to increased acuity and chronic right upper quadrant inflammation in this population. Surgeons should bear these issues in mind in the counseling and care of these patients.