A Comparative Study of Laparoscopic Cholecystectomy in The Elderly And Young
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2019, Vol 18, Issue 2
Abstract
Introduction: Cholelithiasis is one of the most common diseases which requires surgical intervention and is frequently seen in females of both younger and elderly age group. As age increases, repeated attacks of cholecystitis can result in adhesions and chronic inflammatory changes in gall bladder. Laparoscopic cholecystectomy is the gold standard operation of the gall stone disease irrespective of age and is supported by many studies. Laparoscopic cholecystectomy causes less pain after surgery, shorter hospital stay, faster return to work and lower metabolic endocrine immune response to trauma. This procedure has been the gold standard for the last two decades in the general population. It has also demonstrated results superior to open cholecystectomy in elderly patients with symptomatic cholelithiasis in terms of morbidity and hospital stay. The goal of treatment for elderly is to provide them with best possible quality of life with the lowest physiological cost. Several retrospective studies have shown that most elderly patients undergoing laparoscopic cholecystectomy do well, but when compared with younger patients, the elderly have higher rates of conversion to open cholecystectomy, somewhat longer postoperative stays and more complications. Therefore, this study has been conducted to compare the outcome of laparoscopic cholecystectomy in the elderly and young patients. Materials and methods: After obtaining the approval from the research ethics board of the institute, this observational (cross-sectional) study was conducted from October 2015 to September 2017. All 120 patients included underwent laparoscopic cholecystectomy after going through a thorough clinical, radiological and laboratory investigations to confirm the disease process. 120 patients were divided into two groups with 60 in each group, group I with age 20-50years and group II with age of 50-80 years. Chi square test and Fischers exact test were employed in the study. Results: This study shows that laparoscopic cholecystectomy can be performed in any age group. It can also be performed safely in the elderly patients, although the operative time is slightly longer in view of relatively higher incidence of adhesions in and around the Calots triangle. Operative difficulty, rate of conversion, hospital stay and postoperative short term outcome are not influenced by the age of the patient. Conclusion: Laparoscopic cholecystectomy should be considered and encouraged for any age group of patients with symptomatic cholelithiasis who are medically fit. Perioperative outcomes and rate of conversion to open cholecystectomy are not influenced by age and co morbidity but are influenced by the disease process itself, the anatomy of the Calots triangle and experience of the operating laparoscopic surgeon.
Authors and Affiliations
Dr. Piyushkumar Agrawal, Dr. Angela B. Marak, Dr. Digbijoy Krishna Debbarma, Dr. Sreejith V, Dr. ResenRajan S Methikkalam, Dr. Y. Priyabarta Singh, Prof. S Ranita, ProfG. S. Moirangthem
Keywords
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- EP ID EP464297
- DOI 10.9790/0853-1802013450.
- Views 62
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