Laparoscopic Transcystic Common Bile Duct Exploration in the Elderly is as Effective and Safe as in Younger Patients.
BACKGROUND
Choledocholithiasis represents a greater proportion of gallstone in the elderly. Elderly patients have more comorbidity, which could increase the operative risk and postoperative complications. However, no study has focused on the effect and safety of laparoscopic transcystic common bile duct exploration (LTCBDE) in elderly patients. The aim of this study was to investigate whether LTCBDE can be performed effectively and safely in elderly patients.


METHODS
This is a retrospective study of patients who underwent LTCBDE for choledocholithiasis performed from January 2010 to December 2012. Patients of age 70 or older were included in the elderly group. The rest integrated the younger group. Demographic data and perioperative parameters were compared between groups.


RESULTS
From January 2010 to December 2012, 171 patients admitted for choledocholithiasis and gallstone attempted a single-step treatment combining LTCBDE and laparoscopic cholecystectomy. There were 104 women (60.8%) and 67 men (39.2%) with a median age of 57 (range 24-87) years. Elderly patients had significantly more preoperative risk factors. However, there was no significant difference in the success rate of LTCBDE (96.9% versus 92.7%, P = .142) for the two groups. The operative time was a little longer in elderly group than in younger group: median 80 (60-110) minutes versus 70 (50-95) minutes, respectively (P < .001). Postoperative recovery was slower in elderly group than in younger group, as reflected by a longer median postoperative hospital stay (2 days versus 1 day, P < .001) and a higher rate of abdominal drain placed (17.1% versus 8.5%, P = .202). The rates of postoperative complications at discharge were similar between groups (3.0% versus 4.9%, P = .952).


CONCLUSIONS
LTCBDE in the elderly patients is as effective and safe as in younger patients.
1 Department of General Surgery, Beijing Friendship Hospital, Capital Medical University , Beijing, P.R. China .|2 Beijing Key Laboratory of Cancer Invasion and Metastasis Research , Beijing, P.R. China .|3 National Clinical Research Center for Digestive Diseases , Beijing, P.R. China .
Jie-Gao
JG
Zhu
1 Department of General Surgery, Beijing Friendship Hospital, Capital Medical University , Beijing, P.R. China .|2 Beijing Key Laboratory of Cancer Invasion and Metastasis Research , Beijing, P.R. China .|3 National Clinical Research Center for Digestive Diseases , Beijing, P.R. China .
Wei
W
Guo
4 Department of General Surgery, Beijing Luhe Hospital, Capital Medical University , Beijing, P.R. China .
Wei
W
Han
1 Department of General Surgery, Beijing Friendship Hospital, Capital Medical University , Beijing, P.R. China .|2 Beijing Key Laboratory of Cancer Invasion and Metastasis Research , Beijing, P.R. China .|3 National Clinical Research Center for Digestive Diseases , Beijing, P.R. China .
Zhong-Tao
ZT
Zhang
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D042883:Choledocholithiasis / Q000601:surgery*; D003135:Common Bile Duct / Q000601:surgery*; D004322:Drainage; D005260:Female; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
age; common bile duct stones; elderly patients; laparoscopic transcystic bile duct exploration; transcystic stone extraction