Geriatrik Hastalarda Elektif ve Acil Laparoskopik Kolesistektominin Karşılaştırılması

Amaç: Kolelityazis insidansı yaşla birlikte artarken son yıllarda laparoskopik kolesistektomi (LK) geriatrik hastalarda sıklıkla yapılmaktadır. Bu çalışmanın amacı geriatrik hastalarda elektif ve acil LK’ nin sonuçlarını değerlendirmektir. Yöntemler: Ocak 2014-Aralık 2016 tarihleri arasında 65 yaş üstü LK yapılan hastaların tıbbi kayıtları retrospektif olarak tarandı. Bulgular: Kırk altısı acil LK (%38,7), 73’ü elektif LK (%61,3) olmak üzere 119 hasta ameliyat edildi. Konversiyon oranı %5,9’du ve gruplar arası farklılık saptanmadı (p=0,177). Ortalama yaş ve ameliyat süresi sırasıyla 70,3 yıl ile 86 dakikaydı ve acil ile elektif LK arasında anlamlı fark yoktu. Elektif LK uygulanan hastaların hastanede kalış süreleri daha kısa idi (2,11’e karşı 3,15 gün, p=0,0001). Postoperatif komplikasyonlar elektif LK’de 9 hastada, acil LK’de 6 hastada görüldü ve istatiksel olarak gruplar arası anlamlılık görülmedi. Elektif LK grubunda bir hastada mortalite görüldü. Sonuç: Geriatrik hastalarda acil şartlarda yapılan LK daha uzun hastanede yatış süresine sahiptir. Fakat düşük morbidite ve mortalite oranları ile güvenle yapılabilir. İleri yaş acil LK için kontrendikasyon oluşturmaz.

Anahtar Kelimeler:

Geriatri, kolesistektomi, laparoskopik cerrahi, acil, elektif

Comparison of Emergency and Elective Laparoscopic Cholecystectomy in Geriatric Patients

Objective: While the incidence of cholelithiasis increases with age, laparoscopic cholecystectomy (LC) has been more frequently performed in geriatric patients in recent years. This study aimed to analyze the results of elective and emergency LC. Methods: Medical records of patients aged over 65 years who underwent elective and emergency LC between January 2014 and December 2016 were retrospectively analyzed. Results: There were 119 patients; of these, 46 (38.7%) underwent emergency LC (emergency LC group) and 73 (61.3%) underwent elective LC (elective LC group). The conversion rate was 5.9%, and there was no difference between the groups (p=0.177). The mean age of the patients and duration of operation were 70.3 years and 86 min, respectively, and there was no difference between the groups. The hospitalization duration in patients in the elective LC group was shorter than that of those in the emergency LC group (2.11 versus 3.15 days, p=0.0001). Post-operative complications were seen in 9 patients in the elective LC group and 6 patients in the emergency LC group and showed no significant difference. One patient died in the elective LC group. Conclusion: Emergency LC in geriatric patients resulted in a longer hospitalization duration. However, it can be safely performed with low morbidity and mortality rate. Advanced age is not a contraindication for undergoing LC.

Keywords:

Geriatric, cholecystectomy, laparoscopic surgery, emergency, elective,

PDF

___

1. Kuhry E, Jeekel J, Bonjer HJ. Effect of laparoscopy on the immune system. Semin Laparosc Surg 2004; 11: 37-44. [CrossRef] 2. Agrusa A, Romano G, Frazzetta G, Chianetta D, Sorce V, DiBuono G, et al. Role and outcomes of laparoscopic cholecystectomy in the elderly. Int J Surg 2014; 12(Suppl 2): S37-9. [CrossRef] 3. Miura F, Takada T, Strasberg SM, Solomkin JS, Pitt HA, Gouma DJ, et al. TG13 flowchart for the management of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci 2013; 20: 47-54. [CrossRef] 4. Overby DW, Apelgren KN, Richardson W, Fanelli R. SAGES guidelines for the clinical application of laparoscopic biliary tract surgery. Surg Endosc 2010; 24: 2368-86. [CrossRef] 5. Kang KU, Roslyn JJ. Surgical issues for the elderly patient with hepatobiliary disease. Surg Clin North Am 1994; 74: 345-73. 6. Tambyraja AL, Kumar S, Nixon SJ. Outcome of laparoscopic cholecystectomy in patients 80 years and older. World J Surg 2004; 28: 745-8. [CrossRef] 7. Dubois F, Berthelot G, Levard H. Coelioscopic cholecystectomy: experience with 2006 cases. World J Surg 1995; 19: 748-52. [CrossRef] 8. Cingi A, Düşünceli F, Güllüoğlu BM, Yeğen C, Aktan AO, Yalin R. Laparoscopic cholecystectomy: is it a conscious preference among Turkish patients with symptomatic gallstones? - prospective study. World J Surg 2004; 28: 1053-6. [CrossRef] 9. Lee SP, Ko CW. Gallstones. Curr Opin Gastroenterol 2001; 17: 463-7. [CrossRef] 10. Arthur JD, Edwards PR, Chagla LS. Management of gallstone disease in the elderly. Ann R Coll Surg Engl 2003; 85: 91-6. [CrossRef] 11. Albores-de la Riva NX, Chávez-Delgado ME, Servín-Torres E, Velázquez-García JA, Delgadillo-Teller G, Arenas-Osuna J. Surgical complications of gallbladder and the biliary tree in the elderly patients. Rev Med Inst Mex Seguro Soc 2013; 51: 204-11. 12. Kaya İO, Ozkardes A, Ozdemir F, Seker GE, Tokac M, Ozmen MM. Laparoscopic Cholecystectomy in the Elderly. Turk J Med Sci 2006; 36: 357-60. 13. Yetim I, Dervişoğlu A, Karaköse O, Büyükkarabacak Y, Bek Y, Erzurumlu K. Laparoscopic Cholecystectomy Results In Patients With Different Age Groups. J Clin Anal Med 2011; 2: 75-8. [CrossRef] 14. Simopoulos C, Botaitis S, Polychronidis A, Tripsianis G, Karayiannakis AJ. Risk factors for conversion of laparoscopic cholecystectomy to open choleystectomy. Surg Endosc 2005; 19: 905-9. [CrossRef] 15. Agrusa A, Romano G, Frazzetta G, Chianetta D, Sorce V, DiBuono G, et al. Role and outcomes of laparoscopic cholecystectomy in the elderly. Int J Surg 2014; 12(Suppl 2): S37-9. [CrossRef] 16. Majeski J. Laparoscopic cholecystectomy in geriatric patients. Am J Surg 2004; 187: 747-50. [CrossRef]