The comparative effectiveness of laparoscopic over open cholecystectomy is clear from previous data with the advantage of laparoscopy. This epidemiological study delineates that the performance of a laparoscopic approach for cholecystectomy in the elderly lags behind their younger counterparts. selleck kinase inhibitor 5. Conclusion In this large nationwide cross-sectional study of patients undergoing cholecystectomy, we observed an improvement in clinical outcomes for all patients in the laparoscopic arm with a large benefit noted in elderly patients. This coincided with an increasing trend in the adoption of laparoscopic cholecystectomy. Though elderly patients experienced a significant benefit in laparoscopic surgery, with fewer postoperative complications and lower mortality rates, they still lag significantly behind younger patients in undergoing laparoscopic cholecystectomy.

However, we recognise that more data is needed, including data of elderly patients managed as outpatients and the investigation of 1-year mortality rates. Laparoscopic cholecystectomy is a valid primary option for biliary disease and should be considered the procedure of choice in all age groups. Conflict of Interests The authors Anahita Dua (M.D. degree), Abdul Aziz (M.B.Ch.B. degree), Sapan S. Desai (M.D., Ph.D., and M.B.A. degrees), Jason McMaster (M.D. degree), Bhavin Patel, and SreyRam Kuy (M.D. and M.H.S. degrees) have no conflict of interests or financialties to disclose.
From October 7, 2005 to July 31, 2012, 1809 laparoscopic appendectomies were performed. Diagnoses were based on clinical suspicion as well as on ultrasonogram findings.

Under general endotracheal anesthesia, laparoscopy was performed in all the cases. Patients were supine with monitor on the right side and surgeon on the left side of midsection of patient’s body. Assistant stood on the right side of surgeon towards head-end of patient. Three ports were placed: supraumbilical port for telescope, one port just medial to and below the left anterior superior iliac spine, and another just above and to the right of pubic crest (Figure AV-951 1). The telescope was 5mm 30�� in children below 5 years and 10mm 30�� for those above 5 years. The supraumbilical port was introduced by open technique and insufflations were done by keeping CO2 pressure between 10 and 15mmHg. After port placement and insufflations, the right side and foot end of the patient was elevated. For high-up and subhepatic appendix, head-end of the patient needed to be elevated and, on occasions, a fourth port was needed in left flank for retraction of intestines. Bipolar cautery was used to burn the mesoappendix before skeletonization, using monopolar hook cautery.