Retrospective Analysis Of 129 Cases Acute Cholecystitis In Elderly Treated By Laparoscopic Cholecystectomy

Background Acute cholecystitis(AC)is one of the most prevalent surgical diseases in the elderly.Early cholecystectomy is considered to be the gold standard treatment for AC,therefore,in elderly AC patients with other life-threatening comorbidities,considered as the high-risk AC group,LC can lead to high morbidity and mortality during the acute phase.In 2013,a new edition of the has been produced with the aim to define the best surgical treatment for AC according to the grade of severity,the timing,and the procedure.However,few research has addressed the proper operation scheme and timing of laparoscopic cholecystectomy for the elderly and high-risk AC patients at present.Objective We retrospectively study the effect of 129 cases acute cholecystitis in elderly treated by laparoscopic cholecystectomy,aiming to offer guidance to select the operation scheme and timing of laparoscopic cholecystectomy for the elderly and high-risk AC patients.Methods Retrospective analysis of 129 elderly patients with acute cholecystitis who underwent laparoscopic cholecystectomy in General Surgery Department of the Second Affiliated Hospital of Dalian Medical University between January 2014 and November 2015.These patients were divided into 3 groups based on their preoperative treatment:group A,emergency patients(28 patients);group B(22 patients),patients who were treated with PTGBD prior to LC;and group C(79 patients),patients who received nonsurgical treatment prior to LC.General conditions,clinical parameters,severity grade,LC surgery duration,intraoperative blood loss,rate of conversion to open surgery,mortality,intensive care unit(ICU)management,incidence of postoperative complications,histopathology,postoperative hospitalization time and total hospitalization time were analyzed and compared among the 3 groups.Results Among the three groups,the proportion of severe acute cholecystitis patients in group B(45.5%)is significantly higher than the proportion in group A(14.3%)and group C(5.1%),and the differences are statistically significant(P<0.05).With respect to ASA grading,the proportion of patients in group B with grade III and above cholecystitis(63.6%)is significantly higher than the proportion in group A(7.1%)and group C(13.9%)(P<0.05).Ten of them(6 in group A,2 in group B,and 2 in group C)were converted to laparotomy due to the presence of dense adhesions at the triangle of the gallbladder that could not be separated;the conversion rate was 7.8%.The conversion rate of patients in group A was 21.4%,significantly higher than that of group B(9.1%),and group C(2.5%);the difference between group A and group C was statistically significant(P<0.05).The total hospitalization time of the patients in group B(16.4±3.8 days)was significantly longer than that of the patients in group A(5.9±2.1 days)and group C(11.3±7.8 days)(P<0.05).There was no significant difference in the postoperative hospitalization time among three groups(P<0.05).Of these patients,twenty-one(12 in group A,4 in group B,5 in group C;11.4%)were managed in the ICU after surgery.The proportion of ICU management in group A(14.3%)and group B(18.2%)were statistically higher than group C(6.3%)(P<0.05).Through comparison of the incidence of acute and chronic inflammation in patients in the 3 groups,we found that the incidence of acute inflammation in patients in group A(64.3%)and B(45.5%)was significantly higher than in group C(8.9%)(P<0.05);however,the difference compared with group A and B is not statistically significant.Conclusion For these elderly AC patients,the grade of severity according to the Tokyo Guidelines 2013(TG13)was Grade III in admission,local inflammation was severe,could tolerate the emergency operation,emergency LC is recommended to be selected.And those elderly AC patients accompanied by cardiovascular disease,the grade of severity according to TG13 was Grade III in admission,local inflammation was seriously severe,could not tolerate the emergency operation,especially had surgical contraindications,such as receiving anti-thrombotic therapy,priority should be given to the treatment of LC after PTGBD.And PTGBD did not increase the rate of conversion of LC.The other elderly AC patients,the grade of severity according to the TG13 classified as Grade Ⅰ or Ⅱ,LC after conservative treatment would be proper,however,LC is recommended to be performed as early as possible in order to shorten the total hospitalization time.