Dr Kamalakannan, specialising in general and laparascopic surgery at Middle East Hospital, talks about the benefits of laparoscopic procedures for aged patients.
Laparoscopic techniques are gradually replacing many common surgical procedures that are performed in an increasingly ageing population. It places different physiologic demands on the body than in open surgery and such techniques have become more common with improved training, surgeon skill and evidence of enhanced outcomes.
Benefits of laparoscopy include decreased blood loss, post-operative pain and length of hospital stay, as well as improved mobilisation, quicker return to normal activity and fewer pulmonary, thrombotic (blood clot-related) and abdominal wall complications. Indeed, for many common surgical procedures, laparoscopy has become the gold standard, unless contraindicated. Some health concerns where this procedure is used are:
Gallbladder Removal
Gallstone disease disproportionately affects older patients. Currently, 95 per cent of cholecystectomies (removal of the gallbladder) in the United States are performed using the laparoscopic technique. This shift represents one of the fastest and most dramatic transformations in medical and surgical treatment of the last few decades. Those patients who undergo laparoscopic cholecystectomy for elective indications typically return home the same day, while others return home on the first post-operative day.
The overall rates of morbidity (sickness) and mortality (death) remain less with the laparoscopic technique versus open surgery. The reported incidence of morbidity and mortality in elderly patients undergoing open cholecystectomy is about 25 per cent and two per cent respectively. With laparoscopic cholecystectomy, these figures are lowered to 10 per cent and one per cent respectively.
Hernia Repair
Repairing a hernia remains one of the most common issues addressed by the general surgeon. Based on a recent review in Britain, the lifetime incidence of this problem is 27 per cent for men and three per cent for women. The laparoscopic approach gives benefits that include decreased post-operative pain, reduced risk of chronic pain and a faster return to work and daily activities.
Colon Resection
It is estimated that 140,000 new cases of colorectal cancer are diagnosed annually, and 50,000 patients die from the disease each year. About 61 per cent of newly diagnosed colon cancers occurred in patients over 65. Prevalence rates were higher among men than women, particularly in Western countries, presumably due to dietary causes.
Laparoscopic colon resection has added a new treatment modality for patients with colon cancer, ulcerative colitis and Crohn’s Disease.
With its many benefits, laparoscopic surgery is well-suited to respond to the challenges of an ageing population.
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