Yıl: 2022 Cilt: 47 Sayı: 2 Sayfa Aralığı: 548 - 554 Metin Dili: İngilizce DOI: 10.17826/cumj.1000941 İndeks Tarihi: 29-07-2022

Cholecystectomy under epidural anesthesia in elderly patients with significant comorbid conditions

Öz:
Purpose: The aim of this study was to evaluate the surgical treatment of gallstone disease with open cholecystectomy under epidural anesthesia in elderly patients with significant comorbid conditions. Materials and Methods: We retrospectively analyzed 80 consecutive elderly patients over 65 years of age with significant comorbid conditions who underwent open cholecytectomy under epidural anesthesia for the surgical treatment of gallstone disease between January 1, 2009 and December 31, 2019, all performed by one surgeon. Results: Mean age was found 77 ± 16 years.Fifty of the patients (62.5%) were females. Forty-seven patients (58.75%) showed an American Society of Anesthesiologist Physical Status (ASA, PS) of 3. The most frequently associated comorbidity involved the cardiovascular system (46 patients, 57.5%). Surgical indications were acute cholecystitis (AC) in 37 patients (46.25%) and chronic cholecystitis in 32 patients (40%). Mean operation time was 55 ± 22 minutes. Hospital stay was mean 12 ± 5 days. Total complication rate was 38.75%, and pulmonary complication was the most frequently encountered (13.75%). 30-day mortality was seen in 5 patients (6.25%). Conclusion: In older, high-risk gallstone patients, an open cholecystectomy with epidural anesthesia may be recommended. For this patient population, the mortality and morbidity rates are acceptable.
Anahtar Kelime: epidural anesthesia Gallstone disease comorbid conditions high risk patients open cholecystectomy

Önemli komorbid durumları olan yaşlı hastalarda epidural anestezi altında kolesistektomi

Öz:
Amaç: Bu çalışmanın amacı, önemli komorbid durumları olan yaşlı hastalarda epidural anestezi altında açık kolesistektomi ile safra taşı hastalığının cerrahi tedavisini değerlendirmektir. Gereç ve Yöntem: 1 Ocak 2009 ile 31 Aralık 2019 tarihleri arasında safra kesesi taşı cerrahi tedavisi için epidural anestezi altında açık kolesitektomi uygulanan, önemli komorbid durumları olan 65 yaş üstü 80 ardışık yaşlı hastayı geriye dönük olarak inceledik. Hastalar tek bir cerrah tarafından ameliyat edildi. Bulgular: Ortalama yaş 77 ± 16 yıl olarak bulundu. Hastaların 50'si (% 62.5) kadındı. Kırk yedi hastanın (% 58.75) Amerikan Anestezi Uzmanları Derneği Fiziksel Skoru >3 idi. Eşlik eden en sık komorbiditeler kardiyovasküler sistemle ilgili idi (46 hasta, % 57.5). Cerrahi endikasyonlar 37 hastada (% 46.25) akut kolesistit (AK), 32 hastada (% 40) kronik kolesistit idi. Ortalama operasyon süresi 55 ± 22 dakika idi. Ortalama hastanede kalış süresi 12 ± 5 gündü. Toplam komplikasyon oranı % 38.75 olup, en sık pulmoner komplikasyonlar (% 13.75) ile karşılaşıldı. 30 günlük mortalite 5 hastada (% 6.25) görüldü. Sonuç: İleri yaşlı, yüksek riskli safra taşı hastalarında epidural anestezi ile açık kolesistektomi önerilebilir. Bu hasta popülasyonu için mortalite ve morbidite oranları kabul edilebilir düzeydedir.
Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • 1. Tang B, Cushieri A. Conversion during laparoscopic cholecystectomy: risk factors and effects on patient outcome. J Gastrointes Surg. 2006;10:1081-91.
  • 2. Festi D, Dormi A, Capodicasa S, Staniscia T, Attili F, Loria P et al. Incidence of gallstone disease in Italy: results from a multicenter, populationbased Italian study (the MICOL project). World J Gastroenterol. 2008;14:5282-9.
  • 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.
  • 4. Ralls PW, Jeffrey RB Jr, Kane RA. Ultrasonography. Gastroenterol Clin North Am. 2002;31:801-25.
  • 5. Shabanzadeh DM, Sørensen LT, Jørgensen T. A prediction rule for risk stratification of incidentally discovered gallstones: results from a large cohort study. Gastroenterology. 2016;150:156-67.
  • 6. Jarnagin WR (editor). Biliary tract disease. Blumgart's surgery of the liver, biliary tract, and pancreas. 5th ed., Philadelphia: Elsevier Saunders, 2012;489-801.
  • 7. Reynolds W Jr. The first laparoscopic cholecystectomy. JSLS. 2001;5:89-94.
  • 8. Polychronidis A, Laftsidis P, Bounovas A, Simopoulos C. Twenty years of laparoscopic cholecystectomy: Philippe Mouret-March 17, 1987. JSLS. 2008;12:109-11.
  • 9. Keus F, Broeders IA, van Laarhoven CJ. Gallstone disease: Surgical aspects of symptomatic cholecystolithiasis and acute cholecystitis. Best Pract Res Clin Gastroenterol. 2006;20:1031-51.
  • 10. Steinert R, Nestler G, Sagynaliev E, Müller J, Lippert H, Reymond MA. Laparoscopic cholecystectomy and gallbladder cancer. J Surg Oncol. 2006;93:682-9.
  • 11. Malik AM, Laghari AA, Talpur AH, Khan A. Iatrogenic biliary injuries during laparoscopic cholecystectomy. A continuing threat. Int J Surg. 2008;6:392-5.
  • 12. Yokoe M, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Gomi H et al. New diagnostic criteria and severity assessment of acute cholecystitis in revised Tokyo Guidelines. J Hepatobiliary Pancreat Sci. 2012;19:578-85.
  • 13. Borzellino G, de Manzoni G de, Ricci F, Castaldini G, Guglielmi A, Cordian E. Emergency cholecystostomy and subsequent cholecystectomy for acute gallstone cholecystitis in the elderly. Br J Surg. 1999;86:1521-5.
  • 14. Wiggins T, Markar SR, Mackenzie H, Jamel S, Askari A, Faiz O et al. Evolution in the management of acute cholecystitis in the elderly: population-based cohort study. Surg Endosc. 2018;32:4078-86.
  • 15. Escartín A, González M, Cuello E, Pinillos A, Muriel P, Merichal M et al. Acute cholecystitis in very elderly patients: disease management, outcomes and risk factors for compilation. Surg Res Pract. 2019:9709242.
  • 16. Pisano M, Ceresoli M, Cimbanassi S, Gurusamy K, Coccolini F, Borzellino G et al. 2017 WSES and SICG guidelines on acute calculous cholecystitis in elderly population. World J Emerg Surg. 2019;14:1-16.
  • 17. Galizia G, Prizio G, Lieto E, Castellano P, Pelosio L, Imperatore V et al. Hemodynamic and pulmonary changes during open, carbon dioxide pneumoperitoneum, and abdominal wall-lifting cholecystectomy: Aprospective, randomized study. Surg Endosc. 2001;15:477-83.
  • 18. Yetkin G, Uludag M, Oba S, Citgez B, Paksoy I. Laparoscopic cholecystectomy in elderly patients. JSLS. 2009;13:587-91.
  • 19. Loureiro ER, Klein SC, Pavan CC, Almeida LD, da Silva FH, Paulo DN. Laparoscopic cholecystectomy in 960 elderly patients. Rev Col Bras Cir. 2011;38:155- 9.
  • 20. Pearse RM, Moreno RP, Bauer P, Pelosi P, Metnitz P, Spies C et al. Mortality after surgery in Europe: a 7 day cohort study. The Lancet. 2012;380:1059-65.
  • 21. Bhandari TR, Shahi S, Bhandari R, Poudel R. Laparoscopic cholecystectomy in the elderly: an experience at a tertiary care hospital in Western Nepal. Surg Res Pract. 2017;2017:8204578.
  • 22. Lee SI, Na BG, Yoo YS, Mun SP, Choi NK. Clinical outcome for laparoscopic cholecystectomy in extremely elderly patients. Ann Surg Treat Res. 2015;88:145-51.
  • 23. Loozen CS, van Ramshorst B, van Santvoort HC, Boerma D. Acute cholecystitis in elderly patients: A case for early cholecystectomy. J Visc Surg. 2018;155:99-103.
  • 24. Glenn F. Surgical management of acute cholecystitis in patients 65 years of age and older. Ann Surg. 1981;193:56-9.
  • 25. Cho JY, Han H, Yoon Y, Ahn KS. Risk factors for acute cholecystitis and a complicated clinical course in patients with symptomatic cholelithiasis. Arch Surg. 2010;145:329-33.
  • 26. 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.
  • 27. Nikfarjam M, Yeo D, Perini M, Fink MA, Muralidharan V, Starkey G et al. Outcomes of cholecystectomy for treatment of acute cholecystitis in octogenarians. ANZ J Surg. 2014;84:943-8.
  • 28. Zerem E, Omerovic´ S. Can percutaneous cholecystostomy be a definitive management for both acute calculous and acalculous cholecystitis? J Clin Gastroenterol. 2012;46:251.
  • 29. Loozen CS, van Santvoort HC, van Duijvendijk P, Besselink MG, Gouma DJ, Nieuwenhuijzen GA et al. Laparoscopic cholecystectomy versus percutaneous catheter drainage for acute cholecystitis in high risk patients (CHOCOLATE): multicentre randomised clinical trial. Br Med J. 2018;363:k3965.
APA Usta M, Tayar S, Reis M, Ulusahin M, Alhan E (2022). Cholecystectomy under epidural anesthesia in elderly patients with significant comorbid conditions. , 548 - 554. 10.17826/cumj.1000941
Chicago Usta Mehmet Arif,Tayar Serkan,Reis Murat Emre,Ulusahin Mehmet,Alhan Etem Cholecystectomy under epidural anesthesia in elderly patients with significant comorbid conditions. (2022): 548 - 554. 10.17826/cumj.1000941
MLA Usta Mehmet Arif,Tayar Serkan,Reis Murat Emre,Ulusahin Mehmet,Alhan Etem Cholecystectomy under epidural anesthesia in elderly patients with significant comorbid conditions. , 2022, ss.548 - 554. 10.17826/cumj.1000941
AMA Usta M,Tayar S,Reis M,Ulusahin M,Alhan E Cholecystectomy under epidural anesthesia in elderly patients with significant comorbid conditions. . 2022; 548 - 554. 10.17826/cumj.1000941
Vancouver Usta M,Tayar S,Reis M,Ulusahin M,Alhan E Cholecystectomy under epidural anesthesia in elderly patients with significant comorbid conditions. . 2022; 548 - 554. 10.17826/cumj.1000941
IEEE Usta M,Tayar S,Reis M,Ulusahin M,Alhan E "Cholecystectomy under epidural anesthesia in elderly patients with significant comorbid conditions." , ss.548 - 554, 2022. 10.17826/cumj.1000941
ISNAD Usta, Mehmet Arif vd. "Cholecystectomy under epidural anesthesia in elderly patients with significant comorbid conditions". (2022), 548-554. https://doi.org/10.17826/cumj.1000941
APA Usta M, Tayar S, Reis M, Ulusahin M, Alhan E (2022). Cholecystectomy under epidural anesthesia in elderly patients with significant comorbid conditions. Cukurova Medical Journal, 47(2), 548 - 554. 10.17826/cumj.1000941
Chicago Usta Mehmet Arif,Tayar Serkan,Reis Murat Emre,Ulusahin Mehmet,Alhan Etem Cholecystectomy under epidural anesthesia in elderly patients with significant comorbid conditions. Cukurova Medical Journal 47, no.2 (2022): 548 - 554. 10.17826/cumj.1000941
MLA Usta Mehmet Arif,Tayar Serkan,Reis Murat Emre,Ulusahin Mehmet,Alhan Etem Cholecystectomy under epidural anesthesia in elderly patients with significant comorbid conditions. Cukurova Medical Journal, vol.47, no.2, 2022, ss.548 - 554. 10.17826/cumj.1000941
AMA Usta M,Tayar S,Reis M,Ulusahin M,Alhan E Cholecystectomy under epidural anesthesia in elderly patients with significant comorbid conditions. Cukurova Medical Journal. 2022; 47(2): 548 - 554. 10.17826/cumj.1000941
Vancouver Usta M,Tayar S,Reis M,Ulusahin M,Alhan E Cholecystectomy under epidural anesthesia in elderly patients with significant comorbid conditions. Cukurova Medical Journal. 2022; 47(2): 548 - 554. 10.17826/cumj.1000941
IEEE Usta M,Tayar S,Reis M,Ulusahin M,Alhan E "Cholecystectomy under epidural anesthesia in elderly patients with significant comorbid conditions." Cukurova Medical Journal, 47, ss.548 - 554, 2022. 10.17826/cumj.1000941
ISNAD Usta, Mehmet Arif vd. "Cholecystectomy under epidural anesthesia in elderly patients with significant comorbid conditions". Cukurova Medical Journal 47/2 (2022), 548-554. https://doi.org/10.17826/cumj.1000941