Background: Conversion from laparoscopic cholecystectomy to open cholecystectomy leads to the
loss of the advantages of this minimally invasive procedure and significantly increases length of hospital
stay as well as cost. The conversion from laparoscopic to open cholecystectomy is more frequent
among patients with acute cholecystitis and in elderly patients. This study evaluated whether
fundus-first laparoscopic cholecystectomy could lower the conversion rate in geriatric patients with
acute cholecystitis.
Materials and Methods: During a twelve-month period, 112 patients (36 of them age 65 years or older) underwent fundus-first laparoscopic cholecystectomy for acute cholecystitis in a tertiary care
university hospital in central Taiwan.
Results: The conversion rate in the elderly patients was 2.7% (1/36). No major perioperative complications were observed. Minor complications—port-site infection and subhepatic fluid collection—occurred in two patients (5.5%).
Conclusion: Laparoscopic cholecystectomy with a fundus-first approach is a safe, effective operative
procedure for elderly patients with acute cholecystitis when performed by an experienced laparoendoscopic surgeon.
