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Cholecystectomy in Elderly: Challenge and Critical Analysis of Available Evidence

  • Alessandro Puzziello
  • Domenico Landi
  • Fernando Vicinanza
  • Giulia Pacella
  • Giulio Orlando
  • Ileana Maria Luppino
Chapter

Abstract

The incidence of gallstone disease in the elderly population ranges from 14 to 27%. The prevalence of gallstones increases with age and ranges from 20 to 30% in patients aged ≥60 years and increases to 80% in institutionalized individuals aged ≥90 years. Laparoscopic cholecystectomy (LC) is the gold standard for the treatment of gallbladder stone disease. Even though LC has become the gold standard treatment for gallbladder stones, its safety in elderly patients is still questioned. This chapter discusses some aspects of the management and treatment of biliary lithiasis.

Keywords

Laparoscopic cholecystectomy Biliary lithiasis Elderly Endoscopic treatment ERCP 

References

  1. 1.
    Lirussi F, Nassuato G, Passera D, Toso S, Zalunardo B, Monica F, et al. Gallstone disease in an elderly population: the Silea study. Eur J Gastroenterol Hepatol. 1999;11:485–91.CrossRefGoogle Scholar
  2. 2.
    Festi D, Dormi A, Capodicasa S, Staniscia T, Attili AF, Loria P, et al. Incidence of gallstone disease in Italy: results from a multicenter, population-based Italian study (the MICOL project). World J Gastroenterol. 2008;14:5282–9.CrossRefGoogle Scholar
  3. 3.
    Ratner J, Lisbona A, Rosenbloom M, Palayew M, Szabolcsi S, Tupaz T. The prevalence of gallstone disease in very old institutionalized persons. JAMA. 1991;265:902–3.CrossRefGoogle Scholar
  4. 4.
    Tagle FM, Lavergne J, Barkin JS, Unger SW. Laparoscopic cholecystectomy in the elderly. Surg Endosc. 1997;11(6):636–8.CrossRefGoogle Scholar
  5. 5.
    Brunt LM, Quasebarth MA, Dunnegan DL, Soper NJ. Outcomes analysis of laparoscopic cholecystectomy in the extremely elderly. Surg Endosc. 2001;15(7):700–5.CrossRefGoogle Scholar
  6. 6.
    McMahon AJ, Fischbacher CM, Frame SH, MacLeod MC. Impact of laparoscopic cholecystectomy: a population-based study. Lancet. 2000;356(9242):1632–7.CrossRefGoogle Scholar
  7. 7.
    U.S. Bureau of the Census Current population reports, series P-25, N. 952. Projections of the population of the United States by age, sex, and race: 1983–2080. Washington: U.S. Government Printing Office; 1975.Google Scholar
  8. 8.
    Kurbanov FS, Abbasova SF, Aliev IG, Sushko AN, Dobrovol’skii SR. The laparoscopic cholecystectomy in elderly patients. Khirurgiia. 2012;9:38–41.Google Scholar
  9. 9.
    Elwood DR. Cholecystitis. Surg Clin North Am. 2008;88:1241–52.CrossRefGoogle Scholar
  10. 10.
    Bingener J, Richards ML, Schwesinger WH, Strodel WE, Sirinek KR. Laparoscopic cholecystectomy for elderly patients: gold standard for golden years? Arch Surg. 2003;138(5):531–5.CrossRefGoogle Scholar
  11. 11.
    Charfare H, Cheslyn-Curtis S. Selective cholangiography in 600 patients undergoing cholecystectomy with 5-year follow-up for residual bile duct stones. Ann R Coll Surg Engl. 2003;85(3):167–73.CrossRefGoogle Scholar
  12. 12.
    Collins C, Maguire D, Ireland A, Fitzgerald E, O’Sullivan GC. A prospective study of common bile duct calculi in patients undergoing laparoscopic cholecystectomy: natural history of choledocholithiasis revisited. Ann Surg. 2004;239(1):28–33.CrossRefGoogle Scholar
  13. 13.
    Polychronidis A, Botaitis S, Tsaroucha A, et al. Laparoscopic cholecystectomy in elderly patients. J Gastrointestin Liver Dis. 2008;17(3):309–13.PubMedGoogle Scholar
  14. 14.
    Annamaneni RK, Moraitis D, Cayten CG. Laparoscopic cholecystectomy in the elderly. J Soc Laparoendosc Surg. 2005;9(4):408–10.Google Scholar
  15. 15.
    Koivusalo AM, Pere P, Valjus M, Scheinin T. Laparoscopic cholecystectomy with carbon dioxide pneumoperitoneum is safe even for high-risk patients. Surg Endosc. 2008;22(1):61–7.CrossRefGoogle Scholar
  16. 16.
    Magalhaes J, Rosa B, Cotter J. Endoscopic retrograde cholangiopancreatography for suspected choledocholithiasis: from guidelines to clinical practice. World J Gastrointest Endosc. 2015;7(2):128–34.CrossRefGoogle Scholar
  17. 17.
    Ong TZ, Khor JL, Selamat DS, Yeoh KG, Ho KY. Complications of endoscopic retrograde cholangiography in the postMRCP era: a tertiary center experience. World J Gastroenterol. 2005;11:5209–12.PubMedPubMedCentralGoogle Scholar
  18. 18.
    Machi J, Oishi AJ, Tajiri T, Murayama KM, Furumoto NL, Oishi RH. Routine laparoscopic ultrasound can significantly reduce the need for selective intraoperative cholangiography during cholecystectomy. Surg Endosc. 2007;21:270–4.CrossRefGoogle Scholar
  19. 19.
    ASGE Standards of Practice Committee, Maple JT, Ben-Menachem T, Anderson MA, Appalaneni V, Banerjee S, Cash BD, Fisher L, Harrison ME, Fanelli RD, Fukami N, Ikenberry SO, Jain R, Khan K, Krinsky ML, Strohmeyer L, Dominitz JA. The role of endoscopy in the evaluation of suspected choledocholithiasis. Gastrointest Endosc. 2010;71:1–9.CrossRefGoogle Scholar
  20. 20.
    Gurusamy KS, Giljaca V, Takwoingi Y, Higgie D, Poropat G, Štimac D, Davidson BR. Endoscopic retrograde cholangiopancreatography versus intraoperative cholangiography for diagnosis of common bile duct stones. Cochrane Database Syst Rev. 2015;Issue 2.Google Scholar
  21. 21.
    Treckmann J, Sauerland S, Frilling A, Paul A. Common bile duct stones - update 2006. In: Neugebauer EAM, Sauerland S, Fingerhut A, Millat B, Buess G, editors. EAES guidelines for endoscopic surgery. Berlin: Springer; 2006. p. 329–33.CrossRefGoogle Scholar
  22. 22.
    Williams EJ, Green J, Beckingham I, Parks R, Martin D, Lombard M. Guidelines on the management of common bile duct stones (CBDS). Gut. 2008;57:1004–21.CrossRefGoogle Scholar
  23. 23.
    Maple JT, Ikenberry SO, Anderson MA, Appalaneni V, Decker GA, Early D, Evans JA, Fanelli RD, Fisher D, Fisher L, Fukami N, Hwang JH, Jain R, Jue T, Khan K, Krinsky ML, Malpas P, Ben-Menachem T, Sharaf RN, Dominitz JA. The role of endoscopy in the management of choledocholithiasis. Gastrointest Endosc. 2011;74:731–44.CrossRefGoogle Scholar
  24. 24.
    He H, Tan C, Wu J, Dai N, Hu W, Zhang Y, Laine L, Scheiman J, Kim JJ. Accuracy of ASGE high-risk criteria in evaluation of patients with suspected common bile duct stones. Gastrointest Endosc. 2017.Google Scholar
  25. 25.
    Costi R, Gnocchi A, Di Mario F, Sarli L. Diagnosis and management of choledocholithiasis in the golden age of imaging, endoscopy and laparoscopy. World J Gastroenterol. 2014;20(37):13382–401.CrossRefGoogle Scholar
  26. 26.
    Sugiyama M, Atomi Y. Endoscopic sphincterotomy for bile duct stones in patients 90 years of age and older. Gastrointest Endosc. 2000;52:187–91.CrossRefGoogle Scholar
  27. 27.
    Bergman JJ, Rauws EA, Tijssen JG, Tytgat GN, Huibregtse K. Biliary endoprostheses in elderly patients with endoscopically irretrievable common bile duct stones: report on 117 patients. Gastrointest Endosc. 1995;42:195–201.CrossRefGoogle Scholar
  28. 28.
    De Palma GD, Catanzano C. Stenting or surgery for treatment of irretrievable common bile duct calculi in elderly patients? Am J Surg. 1999;178:390–3.CrossRefGoogle Scholar
  29. 29.
    Costi R, DiMauro D, Mazzeo A, Boselli AS, Contini S, Violi V, Roncoroni L, Sarli L. Routine laparoscopic cholecystectomy after endoscopic sphincterotomy for choledocholithiasis in octogenarians: is it worth the risk? Surg Endosc. 2007;21:41–7.CrossRefGoogle Scholar
  30. 30.
    Tambyraja AL, Kumar S, Nixon SJ. Outcome of laparoscopic cholecystectomy in patients 80 years and older. World J Surg. 2004;28(8):745–8.CrossRefGoogle Scholar
  31. 31.
    Kirshtein B, Bayme M, Bolotin A, Mizrahi S, Lantsberg L. Laparoscopic cholecystectomy for acute cholecystitis in the elderly: is it safe? Surg Laparosc Endosc Percutan Tech. 2008;18(4):334–9.CrossRefGoogle Scholar
  32. 32.
    Yetkin G, Uludag M, Oba S, Citgez B, Paksoy I. Laparoscopic cholecystectomy in elderly patients. J Soc Laparoendosc Surg. 2009;13:587–91.CrossRefGoogle Scholar
  33. 33.
    Lujan JA, Sanchez-Bueno F, Parrilla P, Robles R, Torralba JA, Gonzalez-Costea R. Laparoscopic vs. open cholecystectomy in patients aged 65 and older. Surg Laparosc Endosc. 1998;8(3):208–10.CrossRefGoogle Scholar
  34. 34.
    Feldman MG, Russell JC, Lynch JT, Mattie A. Comparison of mortality rates for open and closed cholecystectomy in the elderly: Connecticut statewide survey. J Laparoendosc Surg. 1994;4(3):165–72.CrossRefGoogle Scholar
  35. 35.
    Lasithiotakis K, Petrakis J, Venianaki M, Georgiades G, Koutsomanolis D, Andreou A, Zoras O, Chalkiadakis G. Frailty predicts outcome of elective laparoscopic cholecystectomy in geriatric patients. Surg Endosc. 2013;27(4):1144–50.CrossRefGoogle Scholar
  36. 36.
    Kuy S, Sosa JA, Roman SA, Desai R, Rosenthal RA. Age matters: a study of clinical and economic outcomes following cholecystectomy in elderly Americans. Am J Surg. 2011;201:789–96.CrossRefGoogle Scholar
  37. 37.
    Yang TF, Guo L, Wang Q. Evaluation of preoperative risk factor for converting 15. Laparoscopic to open cholecystectomy: a meta-analysis. Hepato-Gastroenterology. 2014;61(132):958–65.PubMedGoogle Scholar
  38. 38.
    Chang WT, Yu FJ, Hsieh MY, Huang MC, Lee KT, Chen JS, et al. Laparoscopic cholecystectomy in aged patients. Hepato-Gastroenterology. 2009;56(93):950–5.PubMedGoogle Scholar
  39. 39.
    Kwon AH, Matsui Y. Laparoscopic cholecystectomy in patients aged 80 years and over. World J Surg. 2006;30(7):1204–10.CrossRefGoogle Scholar
  40. 40.
    Chesney T, Acuna A. Do elderly patients have the most to gain from laparoscopic surgery? Ann Med Surg. 2015;4(3):321–3.CrossRefGoogle Scholar
  41. 41.
    Clergue F, Morel P, Pastor C. Perioperative management of patients 10. With increased risk of laparoscopy- induced hepatic hypoperfusion. Swiss Med Wkly. 2004;134(3–4):39–43.PubMedGoogle Scholar
  42. 42.
    O’Leary E, Hubbard K, Tormey W, Cunningham AJ. Laparoscopic cholecystectomy: haemodynamic and neuroendocrine responses after pneumoperitoneum and changes in position. Br J Anaesth. 1996;76(5):640–4.CrossRefGoogle Scholar
  43. 43.
    Struthers AD, Cuschieri A. Cardiovascular consequences of laparoscopic surgery. Lancet. 1998;352(9127):568–70.CrossRefGoogle Scholar
  44. 44.
    Fuks D, Duhaut P, Mauvais F, Pocard M, Haccart V, Paquet JC, et al. A retrospective comparison of older and younger adults undergoing early laparoscopic cholecystectomy for mild to moderate calculous cholecystitis. J Am Geriatr Soc. 2015;63:1010–6.CrossRefGoogle Scholar
  45. 45.
    Yokoe M, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Gomi H, et al. TG13 diagnostic criteria and severity grading of acute cholecystitis. J Hepatobiliary Pancreat Sci. 2013;20:35–46.CrossRefGoogle Scholar
  46. 46.
    Fukami Y, Kurumiya Y, Mizuno K, Sekoguchi E, Kobayashi S. Cholecystectomy in octogenarians: be careful. Updat Surg. 2014;66:265–8.CrossRefGoogle Scholar
  47. 47.
    Pessaux P, Regenet N, Tuech JJ, Rouge C, Bergamaschi R, Arnaud JP. Laparoscopic versus open cholecystectomy: a prospective comparative study in the elderly with acute cholecystitis. Surg Laparosc Endosc Percutan Tech. 2001;11(4):252–5.CrossRefGoogle Scholar
  48. 48.
    Hazzan D, Geron N, Golijanin D, Reissman P, Shiloni E. Laparoscopic cholecystectomy in octogenarians. Surg Endosc. 2003;17(5):773–6.CrossRefGoogle Scholar
  49. 49.
    Antoniou SA, Antoniou GA, Koch OO, Pointner R, Granderath FA. Meta- analysis of laparoscopic vs open cholecystectomy in elderly patients. World J Gastroenterol. 2014;20(46):17626–34.CrossRefGoogle Scholar
  50. 50.
    Loozen CS, van Ramshorst B, van Santvoort HC, Boerma D. Early cholecystectomy for acute cholecystitis in the elderly population: a systematic review and meta-analysis. Dig Surg. 2017.  https://doi.org/10.1159/000455241.
  51. 51.
    Kim KH, Sung CK, Park BK, Kim WK, Oh CW, Kim KS. Percutaneous gallbladder drainage for delayed laparoscopic cholecystectomy in patients with acute cholecystitis. Am J Surg. 2000;179:111–3.CrossRefGoogle Scholar
  52. 52.
    Fried GM, Clas D, Meakins JL. Minimally invasive surgery in the elderly patient. Surg Clin North Am. 1994;74(2):375–87.PubMedPubMedCentralGoogle Scholar
  53. 53.
    Simopoulos C, Botaitis S, Polychronidis A, Tripsianis G, Karayiannakis AJ. Risk factors for conversion of laparoscopic cholecystectomy to open cholecystectomy. Surg Endosc. 2005;19(7):905–9.CrossRefGoogle Scholar
  54. 54.
    Lim KR, Ibrahim S, Tan NC, Lim SH, Tay KH. Risk factors for conversion to open surgery in patients with acute cholecystitis undergoing interval laparoscopic cholecystectomy. Ann Acad Med Singap. 2007;36(8):631–5.PubMedGoogle Scholar
  55. 55.
    Puzziello A, Orlando G, Siani C, Gervasi R, Lerose MA, Lucisano AM, Vescio G, Sacco R. From 3-port to new laparoendoscopic single-site (LESS) cholecystectomy: a critical analysis of available evidence.Google Scholar
  56. 56.
    Barkun JS, Aronson JK, Feldman LS, et al. Evaluation and stages of surgical innovations. Lancet. 2009;374:1089–96.CrossRefGoogle Scholar
  57. 57.
    Joris JL, Chiche JD, Canivet JL, Jacquet NJ, Legros JJ, Lamy ML. Hemodynamic changes induced by laparoscopy and their endocrine correlates: effects of clonidine. J Am Coll Cardiol. 1998;32:1389–96.CrossRefGoogle Scholar
  58. 58.
    Clegg A. Frailty in elderly people. Lancet. 2013;381:752–62.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Alessandro Puzziello
    • 1
  • Domenico Landi
    • 1
  • Fernando Vicinanza
    • 1
  • Giulia Pacella
    • 1
  • Giulio Orlando
    • 2
  • Ileana Maria Luppino
    • 3
  1. 1.General and Day Surgery Unit, AOU San Giovanni di Dio e Ruggi d’Aragona, Department of Medicine Surgery and DentistryUniversity of SalernoSalernoItaly
  2. 2.University Magna Graecia of CatanzaroCatanzaroItaly
  3. 3.Gastroenterology and Endoscopy UnitAO AnnunziataCosenzaItaly

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