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KMID : 0371320030640020160
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Journal of the Korean Surgical Society
2003 Volume.64 No. 2 p.160 ~ p.164
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Laparoscopic Cholecystectomy in the Elderly Patients
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Kim Hyung-Ook
Shin Jun-Ho
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Abstract
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Purpose: A laparoscopic cholecystectomy has been the treatment of choice for treating diseases of the gallbladder. As the life expectancy in the elderly continues to increase, the incidence of gallstones increases with age and gallstone complications are seen more frequently in the elderly. This retrospective comparative study was undertaken to assess the efficacy and the risk of a laparoscopic cholecystectomy in older patients.
Methods: From December 1998 to December 2001, 500 patients underwent a laparoscopic cholecystectomy at our department. The two groups of patients included 432 patients younger than 64 years of age (group 1) and 68 patients older than 65 years of age (group 2). The charts were reviewed for the patient’s age, sex, associated medical diseases, final diagnosis, operation time, occurrence of conversion from a laparoscopic to an open cholecystectomy, surgical complications, and hospital stay.
Results: The mean age was 47.0 (group 1), 69.8 years (group 2) and the male-to-female ratio was 1：1.25 (group 1), 1：1.13 (group 2). 17.4% from group 1 and 11.8% from group 2 had a history of previous abdominal surgery. 20.1% from group 1 and 17.4% from group 2 had associated geriatric diseases such as hypertension or diabetes mellitus. The most common final diagnosis was chronic cholecystitis in both groups. However the incidence of acute cholecystitis was 35.8% in group 2 and 18.3% in group 1 (P＜0.05). The mean operation time was 45.1 minutes (group 1) and 45.8 minutes (group 2). Conversion to an open cholecystectomy was required in 4 patients (0.93%) from group 1 and 2 patients (2.94%) from group 2 (P＞0.05). The surgical complication rate was 2.31% (group 1) and 2.94% (group 2) (P＞0.05). The lenght of hospital stay was 3.79 days (group 1) and 4.38 days (group 2) (P＞0.05).
Conclusion: Laparoscopic cholecystectomy is also a safe and effective treatment in older patients. Therefore, older cholecystitis patients should be treated actively with a laparoscopic cholecystectomy to the decrease the morbidity time and the need for an open cholecystectomy that has high mortality rate in older patients. However, this result might be best reserved for those surgeons with significant experience and excellent skill.
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KEYWORD
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Elderly, Cholecystitis, Laparoscopic cholecystectomy
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