- Research article
- Open Access
Elective and emergency laparoscopic cholecystectomy in the elderly: our experience
- Alessia G Ferrarese1Email author,
- Mario Solej†1,
- Stefano Enrico†1,
- Alessandro Falcone†1,
- Silvia Catalano†1,
- Giada Pozzi†1,
- Silvia Marola†1 and
- Valter Martino†1
© Ferrarese et al; licensee BioMed Central Ltd. 2013
- Published: 8 October 2013
We aimed to analyze outcomes of early and delayed laparoscopic cholecystectomy in the elderly in our General Surgery Division.
We analyzed 114 LC performed from the 1st of January 2008 to the 31st of December 2012 in our General Surgery division: 67 LC were performed for gallbladder stones and 47 for acute cholecystitis.
Results and discussion
Comparison between Ordinary and Emergency groups showed that drain placement and post-operative hospital stay were significatively different. There were no significative differences between Early Laparoscopic Emergency Cholecystectomy (E-ELC) and Delayed Laparoscopic Emergency Cholecystectomy (D-ELC). There weren't any differences about Team's evaluation.
We consider LC a safe and effective treatment for cholelitiasis and acute cholecystitis in Ordinary and Emergency setting, also in the elderly. We also demonstrate that, in our experience, LC for AC is feasible as well.
- Laparoscopic Cholecystectomy
- Acute Cholecystitis
- Gallbladder Stone
- Total Hospital Stay
- Emergency Group
Laparoscopic cholecystectomy (LC) represents the gold standard treatment for cholelithiasis.
Its application gradually extended to acute cholecystitis (AC) also in the elderly. We aimed to compare outcomes of the University Section of General Surgery in "San Luigi Gonzaga" Hospital of Orbassano (Turin) with literature, evaluating timing and technique of early or delayed laparoscopic cholecystectomy in the management of acute cholecystitis in elderly patients.
Definitions of team according to the experience of the lead surgeon
More than 100 laparoscopic cholecistectomy and more than 100 other laparoscopic operations.
Less than 100 laparoscopic cholecistectomy and less than 100 other laparoscopic operations.
Surgeons in learning curve progression or Resident with expert Surgeon supervisor
Statistical proportions related to the analyzed dichotomic variables, for both E-ELC and D-ELC (gender distribution in different patient groups, number of post-operative complications, conversion rate, number of drains, number of other related surgeries, presence of fever, wall thickening, effusion amount, gallbladder distension and calculosis type) were compared using Chi-square test and Fisher's exact test. Continuous variables like age distribution, post-operative hospital stay time, surgery duration and several haematochemical characteristics (WBC, CRP) were expressed as average (range) and analyzed using the Mann-Witney U test. Patient distribution according to different surgical teams was confirmed. All statistical analyses were performed using R software (version 2.6.2), and a p value of less than 0.01 was considered indicative of statistical significance.
Statistical analysis based on the comparison of Ordinary vs DEA Groups
Operation time (min)
PO hospital stay (days)
Statistical analysis based on the comparison of E-DLC and D-DLC Groups
Operation time (min)
PO hospital stay (days)
Total hospital stay
p < 0,01
Tasso di conversione
Statistical analysis based on the Team
Team 1-Team 2
Team 1-Team 3
Team 2-Team 3
Operation time (min)
PO hospital stay (days)
Total hospital stay
In agreement with literature [8–10], we consider LC a safe and effective treatment for AC also in the elderly. This study demonstrates that in our experience LC for AC is feasible as well. The learning curve of this procedure is feasible [11, 12]. We also believe that, whenever possible, early LC is to be preferred, above all for the significantly shortened total hospital stay. Nevertheless, the retrospective analysis of our case study, even with a smaller sample for delayed LC patients, showed that elderly patients can be operated with delayed approach and still benefit from the same advantages that would be obtained with an early operation [12–19]. In our experience, according to literature, laparoscopic cholecystectomy is a secure procedure to be performed [20–24]. We consider surgery approach more difficult in the elderly in some cases  but we also considered laparoscopic approach is, in general, a safe and feasible technique in acute pathology and a safe approach also in the elderly .
Funding for this article came from personal funds.
This article has been published as part of BMC Surgery Volume 13 Supplement 2, 2013: Proceedings from the 26th National Congress of the Italian Society of Geriatric Surgery. The full contents of the supplement are available online at http://www.biomedcentral.com/bmcsurg/supplements/13/S2
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