Emergency Laparoscopic Surgery in Very Elderly Patients with Underlying Conditions: Two Case Reports

Abstract

  As increasing surgical procedures for very elderly patients, especially over the age of 85, are performed, maintaining the activity of daily living (ADL) postoperatively is becoming an important issue. We report two cases of very elderly patients who underwent emergency laparoscopic surgery and were discharged without any postoperative complications or ADL decline.
Case 1: A 92-year-old woman who was receiving anticoagulant therapy for chronic atrial fibrillation presented with a chief complaint of persistent abdominal pain. An abdominal MRI revealed a 27×11 cm ovarian tumor. On the third day after admission, the patient developed acute respiratory failure because of compression of the diaphragm caused by a pleural effusion and the ovarian tumor; therefore, the patient underwent emergency laparoscopic surgery.
Case 2: An 89-year-old woman with a history of hypertension who was taking an antiplatelet agent presented at our hospital with a chief complaint of the sudden onset of lower abdominal pain. An abdominal CT scan demonstrated an intra-abdominal tumor and ascites. Rupture of an ovarian tumor was suspected and emergency laparoscopic surgery was performed.
  In both cases, although perioperative intensive care was required, the patients were discharged with a status comparable to their preoperative ADL because of early rehabilitation. Due to the fact that a number of very elderly patients have underlying conditions, appropriate multidisciplinary management of perioperative and postoperative complications are required. If we can apply quality assurance to the performance of minimally invasive laparoscopic surgery, it will facilitate the maintenance of the ADL in very elderly patients.