Proper surgical technique approved for early laparoscopic cholecystectomy for non-critically ill elderly patients with acute cholecystitis.

ABSTRACT

BACKGROUND/AIMS: Either percutaneous cholecystostomy or cholecystectomy are definitive recommendations regarding treatment of elderly or critically ill patients with acute cholecystitis (AC). In this study, we investigated whether early laparoscopic cholecystectomy (ELC) is appropriate for non-critically ill elderly patients with AC with modified surgical technique. METHODOLOGY: A total of 230 non-critically ill elderly patients, who had undergone laparoscopic cholecystectomy (LC) with "suction-curettage" dissection or "open-gallbladder" technique, were retrospectively reviewed, and were divided into three groups based on the length of time from onset of symptoms to surgical intervention (from ELC to delayed intervention). Among the three groups, the operative difficulty, morbidity, mortality, conversion rate, postoperative hospitalization and total hospital stay were compared. RESULTS: There were no significant differences among the three groups with respect to clinical characteristics, conversion rate, the incidences of major postoperative complications and mortality rate. However, the mean operative time and in-hospital stay were significantly shorter, and the estimated blood loss was significantly less in the ELC group than in the delay group (p<0.01). CONCLUSIONS: With "suction-curettage" dissection or "open-gallbladder" technique, LC is a safe and effective treatment for AC in elderly patients at any time. There is no advantage to postponing an early operation in elderly patients with AC.