Author/Editor		Rems, Miran; Lah, Tone; Grubišič, Aleksander; Bahun, Jaka
Title		Katera holecistektomija pri bolnikih starejših od 75 let?
Translated title		Which cholecystectomy for patients older than 75 years?
Type		članek
Source		Endoskopska revija
Vol. and No.		Letnik 3, št. 6
Publication year		1998
Volume		str. 75-8
Language		slo
Abstract		Laparoscopic cholecystectomy (LC) is the most widely used operative treatment for symptomatic gallstones. Despite possible adverse effects of increased intraabdominal pressure, LC has been increasingly used in elderly patients. Patients. During a 2-year period (1996-1997), 34 patients over 75 years of age (mean age 78,5 yrs) were operated on for symptomatic gallstones - 20% by conventional open cholecystectomy (OC) and 80% by laparoscopy. Results. There was no difference in age between the groups. The indications for OC included jaundice, cholangitis and concomitant diseases. The average ASA score in the OC and LC group was 3.1 and 2.3, respectively. Conversion was required in 9% of patients undergoing LC. Mortaility rates were 14.3% for the OC group and 4% for the LC group. Conclusions. LC has proved an effective technique for treating the population of over 75-years-olds. The selection criteria include the patient's health status (ASA) and experience of the operating surgeon. Conversionin LC is a logical step based on sound surgical judgement. High mortality in both groups may have some impact on indications for cholecystectomy in younger patients.
Summary		Laparoskopska holecistektomija (LH) je glavna metoda operiranja simptomatskih žolčnih kamnov. Kljub zadržkom glede stranskih učinkov povišanega tlaka v trebušni votlini se vedno bolj uveljavlja tudi pri starostnikih. Bolniki. V dveletnem obdobju (1996 in 1977) smo operirali 34 bolnikov s simptomatskimi žolčnimi kamni, starejših od 75 let. 20% bolnikov je bilo operiranih klasično, 80% pa laparoskopsko. Povprečna starost vseh operiranih je bila 78,5 let. Rezultati. Indikacija za klasično holecistektomijo (KH) so bili zaporna zlatenica, holangitis in sočasne bolezni. Povprečna vrednost po ASA točkovniku je bila pri bolnikih s KH 3,1 pri LH pa 2,3. Pooperativna ležalna doba laparoskopsko operiranih bolnikov je bila 5,1 dni, klasično operiranih pa 13,6 dni. Pri LH je bilo 9% preklopov. Pri klasično operiranih bolnikih je bila smrtnost 14,3% pri laparoskopsko operiranih pa 4%. Zaključki. LH se izkazuje kot primerna metoda tudi za bolnike, starejše od 75 let. Na izbiro operativne metode vpliva splošno stanje bolnika (primerjava ASA) in izkušenost operaterja. Preklop pri LH je logično nadaljevanje holecistektomije. Visoka smrtnost ima lahko vpliv na indikacije pri mlajših bolnikih.
Descriptors		CHOLELITHIASIS CHOLECYSTECTOMY CHOLECYSTECTOMY, LAPAROSCOPIC AGED TREATMENT OUTCOME