Background : The laparoscopic approach to major intra-abdominal disease appears to be less of an operative stress than are the open procedures. A retrospective study of the outcome of minimally invasive procedures in patients age 65 years or older was undertaken to assess the therapeutic potential, feasibility and the effectiveness of the minimally invasive surgery in the elderly.
Methods : Between February 1998 to January 2000, 140 elderly patients underwent attempted laparoscopic surgery(cholecystectomy, 40; herniorrhaphy, 57; repair of ventral incisional hernia, 11; and other procedures, 32). Patient characteristics, ASA scores, cormobid disease and outcome data were collected retrospectively.
Results : Mean age of the patients was 69.8 years and average ASA score was 2.5 points. Cormobid illness was accompanied in 53 cases(38%). All of 140 laparoscopic procedures were successfully completed without conversion to open surgery and the operative time has no significant difference as open surgery. Analgesic requirements were minimal(360±35.2mg of NSAID, 55±8mg of opiates). Complications occurred in 10cases(7.1%) and 1 mortality was developed. The average length of postoperative stay was 6.0 days.
Conclusions : These results compare favorably with published results of traditional surgery for elderly patients. With careful monitoring of PaCO2 and recognition and aggressive treatment of cormobid disease, the laparoscopic surgery appears to be technically feasible and performed safely and it would be a valid alternative to open surgery. Caution must be exercised when applying these techniques in acute or complicated settings.
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