Önemli komorbid durumları olan yaşlı hastalarda epidural anestezi altında kolesistektomi

Yıl 2022, Cilt: 47 Sayı: 2, 548 - 554, 30.06.2022

Mehmet Arif Usta Serkan Tayar Murat Emre Reis Mehmet Uluşahin Etem Alhan

https://doi.org/10.17826/cumj.1000941

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 Kelimeler

Safra taşı hastalığı, yüksek riskli hastalar, komorbid durumlar, epidural anestezi, açık kolesistektomi

Destekleyen Kurum

yok

Proje Numarası

yok

Teşekkür

yok

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 Kelimeler

Gallstone disease, high risk patients, comorbid conditions, epidural anesthesia, open cholecystectomy

Proje Numarası

yok

Kaynakça

• 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. 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.
• 5. 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.
• 6. 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.
• 7. Escartín A, González M, Cuello E, Pinillos A, Muriel P, Merichal M, et al. Surg Res Pract 2019:9709242. doi:10.1155/2019/9709242.
• 8. Pisano M, Ceresoli M, Cimbanassi S, Gurusamy K, Coccolini F, Borzellino G, et al. 2017 WSES and SICG guidelines on acute calcolouscholecystitis in elderly population. World J Emerg Surg 2019;14:10.
• 9. 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.
• 10. Yetkin G, Uludag M, Oba S, Citgez B, Paksoy I. Laparoscopic cholecystectomy in elderly patients. JSLS 2009;13:587-91.
• 11. Loureiro ER, Klein SC, Pavan CC, Almeida LDLF, Pereira da Silva FH, Paulo DNS. Laparoscopic cholecystectomy in 960 elderly patients. Rev Col Bras Cir 2011;38:155-9.
• 12. Pearse RM, Moreno RP, Bauer P, Pelosi P, Metnitz P, Spies C, et al. Mortality after surgery in Europe: a 7 day cohort study. Lancet 2012;380:1059–65.
• 13. 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.
• 14. 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.
• 15. 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.
• 16. Glenn F. Surgical management of acute cholecystitis in patients 65 years of age and older. Ann Surg 1981;193:56-9.
• 17. 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.
• 18. 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.
• 19. 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.
• 20. Zerem E, Omerovic´ S. Can percutaneous cholecystostomy be a definitive management for both acute calculous and acalculous cholecystitis? J Clin Gastroenterol 2012;46:251.
• 21. Kortram K, van Ramshorst B, Bollen TL, Besselink MGH, Gouma DJ, Karsten T, et al. Acute cholecystitis in high risk surgical patients: percutaneous cholecystostomyversus laparoscopic cholecystectomy (CHOCOLATE trial): study protocol for a randomized controlled trial. Trials 2012;13:1-7.