Our Summary

Gallstones commonly affect older people, but doctors often hesitate to perform surgery due to fears of poor results. This research aimed to gather existing evidence to assess the outcomes of a specific type of gallstone surgery (laparoscopic cholecystectomy) in people over 80 compared to younger patients.

The study looked at factors like total complications, death rates, surgical changes, bile duct injury, and hospital stay lengths in both age groups. It reviewed 12 studies involving 366,522 patients. The results showed that older patients tended to have more complex gallstone disease and other health issues. Younger patients had a lower risk of complications and a slightly lower chance of needing changes in surgery. However, older patients had longer hospital stays.

There was no significant difference in death rates or bile duct injuries between the two age groups in almost all studies. The study concluded that this type of surgery is safe and effective for very elderly patients. The higher rate of complications in this age group is mainly due to their other health issues and the complexity of their gallstone condition.

It suggests that patients should be chosen carefully for surgery, and it should be done sooner to reduce these problems.

FAQs

  1. Is laparoscopic cholecystectomy safe for elderly patients over the age of 80?
  2. What are the complication rates for laparoscopic cholecystectomy in elderly patients compared to younger ones?
  3. Does the length of stay in the hospital increase for elderly patients undergoing laparoscopic cholecystectomy?

Doctor’s Tip

A doctor might advise a patient undergoing laparoscopic cholecystectomy to carefully follow post-operative instructions, including managing pain, avoiding heavy lifting, and taking prescribed medications as directed. It is also important for the patient to stay well-hydrated and gradually resume normal activities as tolerated. Finally, patients should follow up with their doctor for any concerns or complications post-surgery.

Suitable For

Patients who are typically recommended for laparoscopic cholecystectomy include those with symptomatic gallstones, recurrent episodes of gallbladder inflammation (cholecystitis), or complications such as gallbladder obstruction or pancreatitis. In the study mentioned above, it was found that laparoscopic cholecystectomy is safe and effective in the extreme elderly population (>80 years old), although they may have higher complication rates due to more complex gallbladder disease and increased co-morbidities. Patients should be carefully selected for surgery, and cholecystectomy should be performed at an earlier stage to minimize potential complications.

Timeline

Before laparoscopic cholecystectomy:

  1. Patient presents with symptoms of gallstones such as abdominal pain, nausea, vomiting, and jaundice.
  2. Patient undergoes diagnostic tests such as ultrasound or CT scan to confirm the presence of gallstones.
  3. Patient may be advised to make dietary changes or take medications to manage symptoms.
  4. If symptoms persist or if complications arise, patient may be recommended for laparoscopic cholecystectomy.

After laparoscopic cholecystectomy:

  1. Patient undergoes pre-operative evaluation and preparation for surgery.
  2. Laparoscopic cholecystectomy is performed under general anesthesia.
  3. Patient typically experiences less pain and a quicker recovery compared to traditional open surgery.
  4. Patient is monitored post-operatively for any complications such as bleeding, infection, or bile duct injury.
  5. Patient is discharged from the hospital within a few days and instructed on post-operative care and follow-up appointments.
  6. Patient may gradually resume normal activities and diet as advised by their healthcare provider.

What to Ask Your Doctor

  1. What are the potential risks and benefits of laparoscopic cholecystectomy for someone in my age group (over 80 years old)?
  2. How does my age impact the likelihood of complications during or after the surgery?
  3. Are there any specific factors in my medical history that may affect the success of the procedure?
  4. How will my recovery process differ from that of a younger patient?
  5. What is the expected length of stay in the hospital following the surgery?
  6. Are there any alternative treatment options that may be more appropriate for someone in my age group?
  7. How often do you perform laparoscopic cholecystectomy on elderly patients, and what is your success rate?
  8. What is the likelihood of needing conversion to an open procedure during surgery?
  9. Will I need any additional tests or evaluations before scheduling the surgery?
  10. What are the potential long-term outcomes or complications I should be aware of after the surgery?

Reference

Authors: Lord AC, Hicks G, Pearce B, Tanno L, Pucher PH. Journal: Acta Chir Belg. 2019 Dec;119(6):349-356. doi: 10.1080/00015458.2019.1658356. Epub 2019 Sep 2. PMID: 31437407