title: Which differences do elderly patients present in single-stage treatment for cholecysto-choledocholithiasis?
abstract: Patients with symptomatic gallstones present common bile duct stones in approximately 10% of cases. It is possible to resolve both gallbladder and bile duct stones with a single procedure. The aim of this study is to determine the effectiveness of a single stage procedure for gallbladder and bile duct stones in the elderly patients and to expose the differences between the various techniques. From January 2008 to December 2013, we treated 1540 patients with gallbladder stones. In 152 cases, we also found bile duct stones. 150 of these were treated in a single stage procedure. We divided our patients into 2 groups: Group A was younger than 65 (104 patients); Group B was 65 or older (46 patients). We retrospectively compared sex, ASA score, conversion rate, success rate, post-operative complications, hospital stay, and treatment method. We had no intra-operative mortality. 1 patient in Group B, heart condition (ASA 4), died with multiple organ failure (MOF) 10 days after his operation. ASA score: 3.5 ± 0.5 in A vs 2 ± 0.9 in B (P 0.001), post-operative complications 6% in A vs 18.1% in B (P 0.0325) and hospital stay 4.1 ± 2.3 in A vs 9.5 ± 5.5 in B (P 0.0001) were significantly higher in Group B. No differences were found in term of success rate: 94% in A vs 90% in B (P 0.4944). The procedure used to obtain the clearance of the bile duct showed a different success rate across the two groups: for the patients under 65 years old, trans-cystic clearance (TC-CBDE) was successful in 90% of cases, and only 51% for those older than 65, where we had to recall 49% for laparo-endoscopic rendez-vous (RV-IOERC) (P 0.0014). In conclusion, single stage treatment is safe and effective also to elderly patients. The methods used in patients being younger than 65 years old is what appeared to be significantly different.
authors.affiliation: Department of Experimental and Clinical Sciences, University " G.D'Annunzio", Chieti-Pescara, Italy. Electronic address: above@unich.it.
authors.forename: A
authors.initials: A
authors.lastname: Bove
authors.affiliation: Department of Experimental and Clinical Sciences, University " G.D'Annunzio", Chieti-Pescara, Italy. Electronic address: raffaelladirenzo@tiscali.it.
authors.forename: R M
authors.initials: RM
authors.lastname: Di Renzo
authors.affiliation: Department of Experimental and Clinical Sciences, University " G.D'Annunzio", Chieti-Pescara, Italy. Electronic address: ginopalone@yahoo.it.
authors.forename: G
authors.initials: G
authors.lastname: Palone
authors.affiliation: Department of Experimental and Clinical Sciences, University " G.D'Annunzio", Chieti-Pescara, Italy. Electronic address: vdaddetta@gmail.com.
authors.forename: V
authors.initials: V
authors.lastname: D'Addetta
authors.affiliation: Department of Experimental and Clinical Sciences, University " G.D'Annunzio", Chieti-Pescara, Italy. Electronic address: caldararo85@gmail.com.
authors.forename: F
authors.initials: F
authors.lastname: Caldararo
authors.affiliation: Department of Experimental and Clinical Sciences, University " G.D'Annunzio", Chieti-Pescara, Italy. Electronic address: cristos.antonopulos@hotmail.it.
authors.forename: C
authors.initials: C
authors.lastname: Antonopulos
authors.affiliation: Department of Experimental and Clinical Sciences, University " G.D'Annunzio", Chieti-Pescara, Italy. Electronic address: paolo.panaccio@gmail.com.
authors.forename: P
authors.initials: P
authors.lastname: Panaccio
authors.affiliation: Department of Medicine and Aging Sciences, University " G.D'Annunzio", Chieti-Pescara, Italy. Electronic address: chiarini@unich.it.
authors.forename: S
authors.initials: S
authors.lastname: Chiarini
authors.affiliation: Department of Experimental and Clinical Sciences, University " G.D'Annunzio", Chieti-Pescara, Italy. Electronic address: bongarz@unich.it.
authors.forename: G
authors.initials: G
authors.lastname: Bongarzoni
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002758:Cholangiography; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D041761:Cholecystolithiasis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D042883:Choledocholithiasis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D061887:Conversion to Open Surgery; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Cholecystocholedocholithiasis; Elderly patients; Single stage treatment