Laparoscopic vs. open cholecystectomy in patients aged 65 and older.

Laparoscopic cholecystectomy (LC) has displaced open cholecystectomy (OC) in the management of cholelithiasis. However, there are few studies on the role of this technique in patients who run a high risk of surgical complications. We performed a prospective study in 264 patients aged >65 years undergoing surgery for symptomatic cholelithiasis. They were divided into two groups according to the surgical technique performed: OC (131 patients) and LC (133 patients). Conversion from LC to OC was necessary in 11 patients (8.3%). Mean surgery time was 70.9 min for the OC group and 75 min for the LC group. The LC group had a lower rate of postoperative complications (13.53%) than the OC group (23.6%). The incidence of mild complications was similar in both groups; however, the rate of moderate complications was significantly higher in the OC group. Hospital stay was significantly longer in the OC group (9.9 days) than in the LC group (3.71 days). These results suggest that LC should be indicated in elderly patients, as they are better than those obtained with with OC and involve a lower morbidity rate and shorter hospital stay.

Ultrasonography and computed tomography reduce unnecessary surgery in abdominal rectus sheath haematoma.

BACKGROUND: Rectus sheath haematoma is a rare cause of abdominal pain. If accurately diagnosed, surgery can be avoided in most cases. This study assessed the role of ultrasonography and computed tomography (CT) in the diagnosis of rectus sheath haematoma. METHODS: Thirty cases of rectus sheath haematoma diagnosed over 18 years were reviewed. Mean patient age was 59 years; there were 20 women and ten men. The results of imaging investigations were reviewed to determine their efficiency. Ultrasonography was performed in 21 patients and CT in nine. RESULTS: Arterial hypertension, anticoagulant therapy and strained coughing were the most frequent predisposing factors. The most common clinical manifestation was abdominal pain with a palpable mass. Leucocytosis occurred in 18 patients and the haematocrit fell in 13 patients but markedly in seven. Ultrasonography was diagnostic in 15 of 21 patients imaged, and CT was diagnostic in all nine. Treatment was conservative in 22 patients. Eight patients required surgery: four for diagnosis and four for treatment. CONCLUSION: Surgery can be avoided in most patients with rectus sheath haematoma. Although the numbers were small, CT appeared to be more accurate than ultrasonography in facilitating the diagnosis.

[Cholelithiasis and cancer: a study using precursor changes in a population with low incidence of cholelithiasis]. / Colelitiasis y cáncer: estudio mediante las alteraciones precursoras en una población de baja incidencia de colelitiasis.

In order to assess the role of cholelithiasis in the pathogenesis of gallbladder carcinoma in a low-risk population for cholelithiasis and gallbladder cancer, we have studied the relationship between cholelithiasis and cancer. Our findings suggest that, both the relationship between cancer and cholelithiasis, and the frequency of precursors lesions, are very similar to those obtained in surveys carried out in high-risk populations for both conditions. Our findings bear out our hypothesis that cholelithiasis plays a main role in the pathogenesis of gallbladder carcinoma.