부산대학교 도서관

Aims: Laparoscopic cholecystectomy (LC) is considered to be the gold standard treatment of symptomatic cholelithiasis and acute cholecystitis. However, there is still a controversy about this approach in elderly patients. In some cases, surgeons tend to postpone the LC in elderly patients due to a higher risk of complications. This study evaluated the feasibility of LC in elderly patients, in a comparative approach with adult age patients. Methods: We retrospectively analyzed patients who were operated on with a diagnosis of cholelithiasis or acute cholecystitis at Samsun Training and Research Hospital, General Surgery Unit between December 2015 and December 2019. The patients were divided into two groups: adult age (<65 years of age) and elderly (≥65 years of age). Basic characteristics, American Society of Anesthesiologists (ASA) scores, preoperative ultrasonography (USG) findings and laboratory results, preoperative history of acute cholecystitis or pancreatitis attack, surgery type, complications, length of hospital stay, intensive care unit (ICU) admissions, operation time and mortality were compared between the groups. Results: The study included 620 patients (age, mean±standard deviation; 52±14.9, female 73%), of whom 481 were in the adult group (age, mean±standard deviation; 46±11.5, female 74.7%) and 139 (age, mean±standard deviation; 71±5.8, female 67.7%) were in the elderly group. Patients in the elderly group had higher ASA scores compared with the adult age group (ASA 3; 27.3% vs. 5.8%, p<0.001). Preoperative acute cholecystitis findings on USG (3.7% vs. 7.1%, p=0.08) and history of previous cholecystitis/pancreatitis (19.1% vs. 26.6%, p=0.055) were comparable between the groups. Postoperative complication rates (2.5% vs. 5.7%, p=0.055) and severity of complications according to the Clavien-Dindo (CD) classification (CD 1-2; 1.6% vs. 2.8%, p=0.456) were similar in the two groups. The length of hospital stay (2.5±1.6 days vs. 3.2±2.2 days, p=0.028) and the rate of ICU admission (2.9% vs. 20.8%) were significantly higher in the elderly group compared with the adult age patients. Conclusions: LC is overall a safe and feasible treatment strategy with low complication rates in elderly patients. However, the risk of longer hospital stay and ICU admission were found higher than adult age patients in the current study. [ABSTRACT FROM AUTHOR]