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Special Article
October 1, 2003

Laparoscopic Surgery: An Excellent Approach in Elderly Patients

Author Affiliations

From the Division of General Surgery, Department of Surgery, Georgetown University Hospital, Washington, DC.

Arch Surg. 2003;138(10):1083-1088. doi:10.1001/archsurg.138.10.1083

Hypothesis  A review of the literature will show that laparoscopy is safe and effective for the treatment of surgical diseases in elderly patients.

Data Sources  An electronic search using the PubMed and MEDLINE databases was performed using the term laparoscopy in elderly patients. Literature published in the English language in the past decade was reviewed. Pertinent references from articles and books not identified by the search engines were also retrieved. Relevant surgical textbooks were also reviewed.

Study Selection  All relevant studies that could be obtained regardless of the study design were included.

Data Extraction  All studies that contained material applicable to the topic were considered. Data on patient characteristics and surgical outcomes were abstracted.

Data Synthesis  Sixteen studies evaluated laparoscopic cholecystectomy in the elderly. Compared with open cholecystectomy, elderly patients undergoing the laparoscopic procedure had a lower incidence of complications and a shorter hospitalization. In the 4 studies reporting the results of laparoscopic antireflux surgery in the elderly, the morbidity, mortality, and length of hospital stay were similar to those of younger patients. The elderly had equally good postoperative symptom relief. Ten reports of laparoscopic colon resection in the elderly demonstrated earlier return of bowel function, shorter hospitalization, and less cardiopulmonary morbidity.

Conclusions  Despite underlying comorbidities, individuals older than 65 years tolerate laparoscopic procedures extremely well. Complications and hospitalization are lower than in open procedures. Surgeons need to inform primary care physicians of the excellent result of laparoscopic procedures in the elderly to encourage earlier referrals.