YAŞLI HASTALARDA ERCP SONRASI KOLESİSTEKTOMİ SONUÇLARI

Year 2024, Volume: 25 Issue: 4, 490 - 495, 21.10.2024

Emre Ballı , Fatih Gürsoy , Kübra Ertekin

https://doi.org/10.18229/kocatepetip.1447760

Abstract

AMAÇ: Bu çalışma ile endoskopik retrograd kolanjiopankreatikografi (ERCP) sonrası yapılan kolesistektomi operasyonlarında ileri yaşın laparaskopik kolesistektomi için bir risk faktörü olup olmadığının değerlendirilmesi amaçlanmıştır.
GEREÇ VE YÖNTEM: 01.01.2021 – 01.05.2023 tarihleri arasında Afyonkarahisar Sağlık Bilimleri Üniversitesi Tıp Fakültesi Genel Cerrahi kliniğinde ERCP yapılan ve ERCP işlemi sonrasında ERCP’ye bağlı komplikasyon görülmeyen kolesistektomi yapılmış olan 246 hasta çalışmaya dahil edilmiştir. Hastaların sosyodemografik özellikleri, ameliyat sonrası hastanede kalış süreleri, ameliyat sonrası komplikasyon durumları, laparoskopiden açık ameliyata geçme durumları ve ASA (American Society Anesthesiologists) skorları karşılaştırılmıştır.
BULGULAR: Yaşlara göre ayrılan hasta grupları incelendiğinde postoperatif komplikasyon açısından istatistiksel anlamda fark olmadığı tespit edildi (p=0,433). Her iki grubun ameliyat sonrası hastanede kalış günleri karşılaştırıldığında 75 yaş ve üzeri hastaların, 75 yaş altı hastalara göre daha uzun süre hastanede kaldıkları görülmüştür (p<0,001). Açık ameliyata geçme oranları arasında ise herhangi bir istatistiksel fark olmadığı görülmüştür (p=0,539).
SONUÇ: Mevcut çalışma sonuçları bizlere semptomatik safra kesesi ve safra yolları taşı olan hastalarda yaşa bağlı olmaksızın hastaların tamamlayıcı tedavilerinin yapılması gerektiğini göstermektedir. Yaşlılık, ERCP sonrası laparoskopik kolesistektomi yapılması için bir risk faktörü değildir.

Keywords

ERCP, Kolesistektomi, Komplikasyonlar, Yaşlı.

RESULTS OF CHOLECYSTECTOMY AFTER ERCP IN ELDERLY PATIENTS

Abstract

OBJECTIVE: The purpose of this study was to determine if being older increases the risk of laparoscopic cholecystectomy in cholecystectomy operations performed after endoscopic retrograde cholangiopancreatography (ERCP).
MATERIAL AND METHODS: 246 patients who underwent ERCP at the General Surgery Clinic of Afyonkarahisar Health Sciences University between 01.01.2021 and 01.05.2023 and who underwent cholecystectomy without any ERCP-related complications after the ERCP procedure were included in the study. The sociodemographic characteristics of the patients, postoperative hospital stay, postoperative complications, converting from laparoscopy to open surgery, and ASA (American Society Anesthesiologists) scores were compared.
RESULTS: Upon analyzing the patient groups based on age, it was found that there was no significant variation in terms of postoperative complications (p = 0.433). Patients 75 years of age and older stayed in the hospital longer than patients under 75 years of age (p<0.001), according to a comparison of the postoperative hospital stay days of the two groups. It was observed that there was no statistical difference between the rates of converting to open surgery (p = 0.539).
CONCLUSIONS: The current study results show us that complementary treatments should be applied to patients with symptomatic gallbladder and biliary stones, regardless of age. Old age is not a risk factor for laparoscopic cholecystectomy after ERCP.

Keywords

ERCP, Cholecystectomy, Complications, Elderly

References

• 1. 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(6):789–96.
• 2. Soper NJ, Stockmann PT, Dunnegan DL, Ashley SW. Laparoscopic Cholecystectomy The New “Gold Standard”? Arch Surg. 1992;127:917–21.
• 3. Erenoğlu C, Öztürk A, Uluutku H, et al. 70 Yaş Ve Üzerindeki Hastalarda Uygulanan Laparoskopik Kolesistektomi Sonuçları. End, Lap ve Minimal İnvaziv Cerrahi. 2003;10(1–2):36–40.
• 4. Cook LB, Gunasingha MRMKD, Dishman LS, Bartel LM, Bradley CM, Gosztyla LC. Referral practices are associated with a delay in treatment of symptomatic cholelithiasis and cholecystitis. Am J Surg. 2024;227:96-9.
• 5. Marcelino LP, Thofehrn S, Eyff TF, Bersch VP, Osvaldt AB. Factors predictive of the successful treatment of choledocholithiasis. Surg Endosc. 2022;36(3):1838-46.
• 6. Beaton HL. Surgical considerations. In: Gelb A, editor. Clinical Gastroenterology in the Elderly. New York: Marcel Dekker; 1996: 271–82.
• 7. Paul A, Millat B, Holthausen U, Sauerland S, Neugebauer E. Diagnosis and treatment of common bile duct stones (CBDS): Results of a consensus development conference. Surg Endosc. 1998;12:856–64.
• 8. Hallal AH, Amortegui JD, Jeroukhimov IM, et al. Magnetic resonance cholangiopancreatography accurately detects common bile duct stones in resolving gallstone pancreatitis. J Am Coll Surg. 2005;200:869–75.
• 9. Mutlu N, Bolat R, Yorulmaz F ve ark. Endoskopik retrograd kolanjio pankreatografi (ERCP). Güncel Gastroenteroloji. 2005;10:120–33.
• 10. Köklü S, Parlak E, Yüsel O, Sahin B. Endoscopic retrograde cholangiopancreatography in the elderly: A prospective and comparative study. Age Ageing. 2005;34:572–7.
• 11. Gardenyes J, Roura P, Vallverdú-Cartie H, et al. Endoscopic retrograde cholangiopancreatography for the management of choledocholithiasis in older patients. Rev Esp Enferm Dig. 2024;116(5):244-9.
• 12. Singh S, Bajorek B. Defining “elderly” in clinical practice guidelines for pharmacotherapy. Pharm Pract. 2014;12(4):489.
• 13. Leardi S, De Vita F, Pietroletti R, Simi M. Cholecystectomy for gallbladder disease in elderly aged 80 tears and over. Hepatogastroenterology. 2009;306:303–6.
• 14. Heaton KW. The epidomiology of gallstones and suggested aetiology. Clin Gastroenterol. 1973;2(1):67–83.
• 15. Deenitchin GP, Konomi H, Kimura H, et al. Reappraisal of safety of endoscopic sphincterotomy for common bile duct stones in the elderly. Am J Surg. 1995;170:51–4.
• 16. Irojah B, Bell T, Grim R, Martin J, Ahuja V. Are They Too Old for Surgery? Safety of Cholecystectomy in Superelderly Patients (≥ Age 90). Perm J. 2017;21:16–013.
• 17. Köstenbauer JK, Gandy RC, Close J, Harvey L. Factors Affecting Early Cholecystectomy for Acute Cholecystitis in Older People-A Population-Based Study. World J Surg. 2023;47(7):1704-10.
• 18. Schreurs WH, Vles WJ, Stuifbergen WHNM, Oostvogel HJM. Endoscopic management of common bile duct stones leaving the gallbladder in situ: A cohort study with long-term follow-up. Dig Surg. 2004;21(1):60–4.
• 19. Brunicardi FC (Edited by). Schwartz’s Principles of Surgery 11th Edition. In: Haisley KR, Hunter JG. Chapter 32: Gallbladder and the Extrahepatic Biliary System. McGraw Hill Medical Books 2021:1394-1425.
• 20. Porttncasa P, Stolk MFJ, Van Erpecum KJ, Palasciano G, Van Berge-Henegouwen GP. Cholesterol gallstone formation in man and potential treatments of the gallbladder motility defect. Scand J Gastroenterol. 1995;212:63-78.
• 21. Atay A, Güngör F, Candan MS, et al. Risk factors and clinical outcomes of laparoscopic cholecystectomy in elderly patients. Laparosc Endosc Surg Sci. 2022;29(4):205-10.
• 22. Berggren U, Gordh T, Grama D, Haglund U, Rastad J, Arvidsson D. Laparoscopic versus open cholecystectomy: Hospitalization, sick leave, analgesia and trauma responses. Br J Surg. 1994;81(9):1362–5.
• 23. Dubecz A, Langer M, Stadlhuber RJ, et al. Cholecystectomy in the Very Elderly-Is 90 the New 70? J Gastrointest Surg. 2012;16(2):282–5.
• 24. Amer N, Alarfaj M, Othman S, Alshammary S, Alshammari E. Emergency versus elective cholecystectomy: Experience at a university hospital in the Eastern Province, Saudi Arabia. J Fam Community Med. 2023;30(1):37–41.
• 25. Ábrahám S, Németh T, Benkő R, et al. Evaluation of the conversion rate as it relates to preoperative risk factors and surgeon experience: a retrospective study of 4013 patients undergoing elective laparoscopic cholecystectomy. BMC Surg. 2021;21(1):151.
• 26. Brunt LM, Quasebarth MA, Dunnegan DL, Soper NJ. Outcomes analysis of laparoscopic cholecystectomy in the extremely elderly. Surg Endosc. 2001;15(7):700–5.
• 27. 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. Digestive Surgery. 2017;34(5):371-9.
• 28. 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.
• 29. Coelho JCU, Dalledone GO, Domingos MF, Nassif LT, De-Freitas ACT, Matias JEF. Results of laparoscopic cholecystectomy in the elderly. Rev Col Bras Cir. 2018;45(5):e2020.