Abstract
Background
Acute appendicitis (AA) in elderly patients (60 years of age and older) is a challenging problem associated with significant morbidity and mortality when perforation is present. We hypothesized that laparoscopic appendectomy (LA) would enable an earlier correct diagnosis and have advantages in elderly patients.
Methods
We performed a retrospective review of patients who underwent laparoscopic appendectomy for suspected AA. Data of elderly patients were compared to data of younger patients (18 to <60 years of age).
Results
Fifty-four LA were performed in elderly patients and 423 in younger patients. Patients over the age of 60 years had more co-morbidities and required more frequent use of anticoagulants. Preoperative imaging (ultrasound or computerized tomography) was significantly more frequent in elderly patients (36% versus 15%), and was associated with a higher rate of confirmation of acute appendicitis (78% versus 55%), which allowed a decrease in the rate of negative surgical explorations to 4.1% in elderly patients compared to 10.2% in younger patients. Complicated appendicitis and conversions were more frequent in the elderly patients. This resulted in prolonged operative time and longer hospital stay for this group. The overall complication rate was equivalent in the two groups, without differences in the occurrence either of infectious complications or of complications related to surgical site. There were no deaths following appendectomy in our series.
Conclusions
Laparoscopic appendectomy is safe in the elderly population and is not associated with any increase in morbidity. The high incidence of complicated appendicitis in elderly patients affects operative time and length of hospital stay following laparoscopic appendectomy, and it can also lead to an increased rate of conversion to an open procedure. Use of preoperative abdominal computerized tomography scan is mandatory in elderly patients to provide an early diagnosis and to decrease unnecessary surgical exploration when acute appendicitis is suspected.
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References
Fagbohun CF, Toy EC, Baker B (1999) The evaluation of acute abdominal pain in the elderly patient. Primary Care Update Ob/Gyn 181–185
Sheu BF, Chiu TF, Chen JC et al (2007) Risk factors associated with perforated appendicitis in elderly patients presenting with signs and symptoms of acute appendicitis. Aust N Z J Surg 77:662–666
Franz MG, Norman J, Fabri PJ (1995) Increased morbidity of appendicitis with advancing age. Am Surg 61:40–44
Yamini D, Vargas H, Bongard F et al (1998) Perforated appendicitis: is it truly a surgical urgency? Am Surg 64:970–975
Storm-Dickerson TL, Horattas MC (2003) What have we learned over the past 20 years about appendicitis in the elderly? Am J Surg 185:198–201
Lunca S, Bouras G, Romedea NS (2004) Acute appendicitis in the elderly patient: diagnostic problems, prognostic factors and outcomes. Rom J Gastroenterol 13:299–303
Lee SL, Walsh AJ, Ho HS (2001) Computed tomography and ultrasonography do not improve and may delay the diagnosis and treatment of acute appendicitis. Arch Surg 136:556–562
Fuchs JR, Schlamberg JS, Shortsleeve MJ et al (2002) Impact of abdominal CT imaging on the management of appendicitis: an update. J Surg Res 106:131–136
Hui TT, Major KM, Avital I et al (2002) Outcome of elderly patients with appendicitis: effect of computed tomography and laparoscopy. Arch Surg 137:995–998, discussion 999–1000
Golub R, Siddiqui F, Pohl D (1998) Laparoscopic versus open appendectomy: a metaanalysis. J Am Coll Surg 186:545–553
Chung RS, Rowland DY, Li P et al (1999) A meta-analysis of randomized controlled trials of laparoscopic versus conventional appendectomy. Am J Surg 177:250–256
Paik PS, Towson JA, Anthone GJ et al (1997) Intra-abdominal abscesses following laparoscopic and open appendectomies. J Gastrointest Surg 1:188–193
Krisher SL, Browne A, Dibbins A et al (2001) Intra-abdominal abscess after laparoscopic appendectomy for perforated appendicitis. Arch Surg 136:438–441
Von Titte SN, McCabe CJ, Ottinger LW (1996) Delayed appendectomy for appendicitis: causes and consequences. Am J Emerg Med 14:620–622
Kim K, Lee CC, Song KJ et al (2008) The impact of helical computed tomography on the negative appendectomy rate: a multi-center comparison. J Emerg Med 34:3–6
Gwynn LK (2001) The diagnosis of acute appendicitis: clinical assessment versus computed tomography evaluation. J Emerg Med 21:119–123
Horton MD, Counter SF, Florence MG et al (2000) A prospective trial of computed tomography and ultrasonography for diagnosing appendicitis in the atypical patient. Am J Surg 179:379–381
Laurell H, Hansson LE, Gunnarsson U (2006) Acute abdominal pain among elderly patients. Gerontology 52:339–344
Wang YC, Yang HR, Chung PK et al (2006) Laparoscopic appendectomy in the elderly. Surg Endosc 20:887–889
Guller U, Jain N, Peterson ED et al (2004) Laparoscopic appendectomy in the elderly. Surgery 135:479–488
Galizia G, Prizio G, Lieto E et al (2001) Hemodynamic and pulmonary changes during open, carbon dioxide pneumoperitoneum and abdominal wall-lifting cholecystectomy. A prospective, randomized study. Surg Endosc 15:477–483
Gurusamy KS, Samraj K, Davidson BR (2008) Abdominal lift for laparoscopic cholecystectomy. Cochrane Database Syst Rev CD006574
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Kirshtein, B., Perry, Z.H., Mizrahi, S. et al. Value of Laparoscopic Appendectomy in the Elderly Patient. World J Surg 33, 918–922 (2009). https://doi.org/10.1007/s00268-008-9916-y
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DOI: https://doi.org/10.1007/s00268-008-9916-y