Laparoscopic cholecystectomy in acute cholecystitis in the elderly.

Background/aims: Benefits of using laparoscopic cholecystectomy (LC) in the elderly with acute cholecystitis (AC) is still questionable. Our aim is to carry out a comparative analysis of that intervention in two groups of patients: under 65 years old, and over or equal to 65 years old.

Methodology: This study corresponds to 249 LCs carried out during 4 years at the Emergency and Surgery Department of Hospital de S. João; 2 groups of individuals were considered: group A--under 65 years old, and group B--65 years old or over. The first consisted of 168 cases (88 men and 80 women, mean age 48.34 years (+/- 11.80)); and the second included 81 patients (40 men and 41 women, mean age 75.73 years (+/- 6.87)). The diagnosis was made on the basis of clinical symptoms, leukocytosis and ultrasound.

Results: The comparative analysis between these two groups provided the following results: 1) Mortality: 0% in A vs. 4.76% in B (P = 0.007); 2) Overall postoperative complications: 5.36% in A vs. 22.2% in B (P < 0.001); 3) Surgical complications: 4.76% in A vs. 14.8% in B (P = 0.468); 4) Intraoperative complications: 4.76% in A vs. 4.94% in B (P = 0.007); 5) Reoperations: 2.98% in A vs. 7.41% in B (P = 0.022); 6) Conversion: 12.50% in A vs. 17.28% in B (P = 0.447); 7) Lesion of the Main Bile Duct: 1.79% in A vs. 2.47% in B (P = 0.447); 8) Hospital Stay, equal to or less than 4 days: 72.62% in A vs. 27.16% in B (P <0.001).

Conclusions: LC is a safe and efficient intervention in the treatment of acute cholecystitis in the elderly, although with greater morbidity and longer hospital stay, when compared with younger patients.