<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2444-054X</journal-id>
<journal-title><![CDATA[Cirugía y cirujanos]]></journal-title>
<abbrev-journal-title><![CDATA[Cir. cir.]]></abbrev-journal-title>
<issn>2444-054X</issn>
<publisher>
<publisher-name><![CDATA[Academia Mexicana de Cirugía A.C.]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2444-054X2021000300291</article-id>
<article-id pub-id-type="doi">10.24875/ciru.20000206</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[Safety of laparoscopic cholecystectomy in patients older than 90 years in a private hospital in Ecuador: A case series]]></article-title>
<article-title xml:lang="es"><![CDATA[Seguridad de la colecistectomía laparoscópica en pacientes mayores de 90 años en un hospital privado en Ecuador: una serie de casos]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Lincango-Naranjo]]></surname>
<given-names><![CDATA[Eddy P.]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Negrete-Ocampo]]></surname>
<given-names><![CDATA[Jose R.]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Barberis-Barcia]]></surname>
<given-names><![CDATA[Guiseppe]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Cajas]]></surname>
<given-names><![CDATA[María José]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Campuzano]]></surname>
<given-names><![CDATA[Julio C.]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad Central Medical School ]]></institution>
<addr-line><![CDATA[Quito ]]></addr-line>
<country>Ecuador</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Hospital Vozandes General Surgery Department ]]></institution>
<addr-line><![CDATA[Quito ]]></addr-line>
<country>Ecuador</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>06</month>
<year>2021</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>06</month>
<year>2021</year>
</pub-date>
<volume>89</volume>
<numero>3</numero>
<fpage>291</fpage>
<lpage>294</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S2444-054X2021000300291&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S2444-054X2021000300291&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S2444-054X2021000300291&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Background: The rate of biliary lithiasis and its complications are higher in the elderly. Some authors describe age as the main factor that significantly increases the morbidity and mortality of patients undergoing cholecystectomy.  Objective: The objective of this study was to describe the safety of laparoscopic cholecystectomy, focusing on complication and conversion rates in patients older than 90 years, in a private hospital of a developing country.  Materials and methods: This case-series enrolled patients older than 90 years diagnosed with acute cholecystitis using the Tokyo 2013 criteria. All included patients underwent laparoscopic cholecystectomy from January 2010 to December 2016 at Vozandes Hospital Quito-Ecuador. Frequencies and percentages and mean were reported for categorical and numerical variables, respectively.  Results: We included 15 patients aged between 90 and 96 years. There were three post-operative complications, two cases of hypovolemic shock secondary to bleeding that stop without reoperation (13%) and 1 of delirium (7%). Conversion was performed in two patients (13%) due to the impossibility of visualizing the anatomical structures and obtain an adequate critical view of safety due to gallbladder phlegmon.  Conclusion: Laparoscopic cholecystectomy seems to be a safe approach, with relatively low complication and conversion rates in patients older than 90 years.]]></p></abstract>
<abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen  Antecedentes: La tasa de litiasis biliar y sus complicaciones son mayores en los ancianos. Algunos autores describen la edad como un factor principal que aumenta significativamente la morbilidad y la mortalidad de los pacientes sometidos a colecistectomía.  Objetivo: Describir la seguridad de la colecistectomía laparoscópica centrándose en su tasa de complicaciones y de conversión en pacientes mayores de 90 años, en un hospital privado de un país en desarrollo.  Método: Esta serie de casos incluyó pacientes mayores de 90 años diagnosticados de colecistitis aguda según los criterios Tokio 2013. Todos fueron sometidos a colecistectomía laparoscópica entre enero de 2010 y diciembre de 2016 en el Hospital Vozandes Quito (Ecuador). Se informaron las frecuencias y los porcentajes, y la media, para las variables categóricas y numéricas, respectivamente.  Resultados: Se incluyeron 15 pacientes con edades comprendidas entre los 90 y 96 años. Hubo tres complicaciones posoperatorias, dos casos de shock hipovolémico secundario a sangrado que remitieron sin reoperación (13%) y uno de delirio (7%). Se realizó conversión quirúrgica en dos pacientes (13%) debido a la imposibilidad de visualizar las estructuras anatómicas y lograr una visión crítica adecuada de seguridad por flemón vesicular.  Conclusión: La colecistectomía laparoscópica parece ser un enfoque seguro, con unas tasas de conversión y de complicaciones relativamente bajas, en los pacientes mayores de 90 años.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[Laparoscopic cholecystectomy]]></kwd>
<kwd lng="en"><![CDATA[Acute cholecystitis]]></kwd>
<kwd lng="en"><![CDATA[Elderly patient]]></kwd>
<kwd lng="en"><![CDATA[Ecuador]]></kwd>
<kwd lng="es"><![CDATA[Colecistectomía laparoscópica]]></kwd>
<kwd lng="es"><![CDATA[Colecistitis aguda]]></kwd>
<kwd lng="es"><![CDATA[Paciente anciano]]></kwd>
<kwd lng="es"><![CDATA[Ecuador]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Irojah]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Bell]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Grim]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Martin]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Ahuja]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Are they too old for surgery ?Safety of cholecystectomy in superelderly patients (&#8805;Age 90)]]></article-title>
<source><![CDATA[Perm J]]></source>
<year>2017</year>
<volume>21</volume>
<page-range>16-23</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="">
<collab>Pan American Health Organization</collab>
<source><![CDATA[Ecuador]]></source>
<year></year>
</nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ekici]]></surname>
<given-names><![CDATA[U]]></given-names>
</name>
<name>
<surname><![CDATA[Y&#305;lmaz]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Tatl&#305;]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Comparative analysis of laparoscopic cholecystectomy performed in the elderly and younger patients:should we abstain from laparoscopic cholecystectomy in the elderly?]]></article-title>
<source><![CDATA[Cureus]]></source>
<year>2018</year>
<volume>10</volume>
</nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Wiggins]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Markar]]></surname>
<given-names><![CDATA[SR]]></given-names>
</name>
<name>
<surname><![CDATA[Mackenzie]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Jamel]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Askari]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Faiz]]></surname>
<given-names><![CDATA[O]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Evolution in the management of acute cholecystitis in the elderly :population-based cohort study]]></article-title>
<source><![CDATA[Surg Endosc]]></source>
<year>2018</year>
<volume>32</volume>
<page-range>4078-86</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Van Heesewijk]]></surname>
<given-names><![CDATA[AE]]></given-names>
</name>
<name>
<surname><![CDATA[Lammerts]]></surname>
<given-names><![CDATA[RG]]></given-names>
</name>
<name>
<surname><![CDATA[Haveman]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Meerdink]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Van Leeuwen]]></surname>
<given-names><![CDATA[BL]]></given-names>
</name>
<name>
<surname><![CDATA[Pol]]></surname>
<given-names><![CDATA[RA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Outcome after cholecystectomy in the elderly]]></article-title>
<source><![CDATA[Am J Surg]]></source>
<year>2018</year>
<volume>218</volume>
<page-range>368-73</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Bhandari]]></surname>
<given-names><![CDATA[TR]]></given-names>
</name>
<name>
<surname><![CDATA[Shahi]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Bhandari]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Poudel]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Laparoscopic cholecystectomy in the elderly:an experience at a tertiary care hospital in Western Nepal]]></article-title>
<source><![CDATA[]]></source>
<year>2017</year>
<volume>2017</volume>
<page-range>8204578</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[De la Serna]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Ruano]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Pérez-Jiménez]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Rojo]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Avellana]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[García-Botella]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Safety and feasibility of cholecystectomy in octogenarians. Analysis of a single center series of 316 patients]]></article-title>
<source><![CDATA[HPB (Oxford)]]></source>
<year>2019</year>
<volume>21</volume>
<page-range>1570-6</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Lord]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Hicks]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Pearce]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Tanno]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Pucher]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Safety and outcomes of laparoscopic cholecystectomy in the extremely elderly:a systematic review and meta-analysis]]></article-title>
<source><![CDATA[Acta Chir Belg]]></source>
<year>2019</year>
<volume>119</volume>
<page-range>349-56</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Yokoe]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Takada]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Strasberg]]></surname>
<given-names><![CDATA[SM]]></given-names>
</name>
<name>
<surname><![CDATA[Solomkin]]></surname>
<given-names><![CDATA[JS]]></given-names>
</name>
<name>
<surname><![CDATA[Mayumi]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Gomi]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[TG13 diagnostic criteria and severity grading of acute cholecystitis (with videos)]]></article-title>
<source><![CDATA[J Hepatobiliary Pancreat Sci]]></source>
<year>2013</year>
<volume>20</volume>
<page-range>35-46</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Riall]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Adhikari]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Parmar]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Linder]]></surname>
<given-names><![CDATA[SK]]></given-names>
</name>
<name>
<surname><![CDATA[Dimou]]></surname>
<given-names><![CDATA[FM]]></given-names>
</name>
<name>
<surname><![CDATA[Crowell]]></surname>
<given-names><![CDATA[W]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The risk paradox:use of elective cholecystectomy in older patients is independent of their risk of developing complications]]></article-title>
<source><![CDATA[J Am Coll Surg]]></source>
<year>2015</year>
<volume>220</volume>
<page-range>682-90</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Lyu]]></surname>
<given-names><![CDATA[Y]]></given-names>
</name>
<name>
<surname><![CDATA[Cheng]]></surname>
<given-names><![CDATA[Y]]></given-names>
</name>
<name>
<surname><![CDATA[Wang]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Zhao]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Chen]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Early versus delayed laparoscopic cholecystectomy for acute cholecystitis:an up-to-date meta-analysis of randomized controlled trials]]></article-title>
<source><![CDATA[Surg Endosc]]></source>
<year>2018</year>
<volume>32</volume>
<page-range>4728-41</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Loozen]]></surname>
<given-names><![CDATA[CS]]></given-names>
</name>
<name>
<surname><![CDATA[Van Ramshorst]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Van Santvoort]]></surname>
<given-names><![CDATA[HC]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Early cholecystectomy for acute cholecystitis in the elderly population:a systematic review and meta-analysis]]></article-title>
<source><![CDATA[]]></source>
<year>2017</year>
<volume>34</volume>
<page-range>371-9</page-range></nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Escart]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Gonz]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Cuello]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Pinillos]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Muriel]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Merichal]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Acute cholecystitis in very elderly patients:disease management, outcomes, and risk factors for complications]]></article-title>
<source><![CDATA[Surg Res Pract]]></source>
<year>2019</year>
<volume>2019</volume>
<page-range>9709242</page-range></nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Pisano]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Ceresoli]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Cimbanassi]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Gurusamy]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Coccolini]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Borzellino]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[2017 WSES and SICG guidelines on acute calcolous cholecystitis in elderly population]]></article-title>
<source><![CDATA[World J Emerg Surg]]></source>
<year>2019</year>
<volume>7</volume>
<page-range>1-16</page-range></nlm-citation>
</ref>
<ref id="B15">
<label>15</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Cheng]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Clymer]]></surname>
<given-names><![CDATA[JW]]></given-names>
</name>
<name>
<surname><![CDATA[Po-Han Chen]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Sadeghirad]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Ferko]]></surname>
<given-names><![CDATA[NC]]></given-names>
</name>
<name>
<surname><![CDATA[-Cameron]]></surname>
<given-names><![CDATA[CG]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Prolonged operative duration is associated with complications:a systematic review and meta-analysis]]></article-title>
<source><![CDATA[J Surg Res]]></source>
<year>2018</year>
<volume>229</volume>
<page-range>134-44</page-range></nlm-citation>
</ref>
<ref id="B16">
<label>16</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Oymaci]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Ucar]]></surname>
<given-names><![CDATA[AD]]></given-names>
</name>
<name>
<surname><![CDATA[Aydogan]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Sari]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Erkan]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Yildirim]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Evaluation of affecting factors for conversion to open cholecystectomy in acute cholecystitis]]></article-title>
<source><![CDATA[Prz Gastroenterol]]></source>
<year>2014</year>
<volume>9</volume>
<page-range>336-41</page-range></nlm-citation>
</ref>
<ref id="B17">
<label>17</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Loozen]]></surname>
<given-names><![CDATA[CS]]></given-names>
</name>
<name>
<surname><![CDATA[Van Ramshorst]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Van Santvoort]]></surname>
<given-names><![CDATA[HC]]></given-names>
</name>
<name>
<surname><![CDATA[Boerma]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Acute cholecystitis in elderly patients:a case for early cholecystectomy]]></article-title>
<source><![CDATA[J Visc Surg]]></source>
<year>2018</year>
<volume>155</volume>
<page-range>99-103</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
