Background: The incidence of gallstones increases with age and as the proportion of the population
65 years of age and older continues to grow, increased demand for laparoscopic cholecystectomy
(LC) in the geriatric population is likely. LC has advantages over open cholecystectomy, but comparative
evaluation of the procedure in elderly patients is lacking.
Methods: We performed a two-year review of patients undergoing LC at our institution. Demographic
information, diagnosis, operation performed, and operative complications were recorded.
Patients were placed into two groups by age: 65 years and older, and those younger than 65 years
of age. Primary outcome measures were complication rate and conversions to laparotomy.
Results: A total of 315 patients underwent LC during the study period, of whom 59 (19%) were
65 years of age or older. The older age group experienced higher rates of conversion to an open
procedure (22% vs. 2.7%, P < 0.05), and operative complications (17% vs. 3.1%, P < 0.05). Elderly
patients also had longer operative times (108 ± 55 minutes vs. 83 < 34 minutes, P < 0.05). Acute
(31% vs. 16%) and chronic (14% vs. 7.4%) cholecystitis were the operative diagnoses in a greater
proportion of patients in the older age group, and elderly patients were more likely to have had
prior upper abdominal surgery (8.5% vs. 1.6%, P < 0.05).
Conclusion: LC in the geriatric population carries increased risk for conversion to laparotomy
and operative complications compared to LC in younger patients. This is likely due to increased
acuity and chronic right upper quadrant inflammation in this population. Surgeons should bear
these issues in mind in the counseling and care of these patients.
