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Surgical Endoscopy
Published in: Surgical Endoscopy 6/2017

01-06-2017

Laparoscopic common bile duct exploration: a safe and definitive treatment for elderly patients

Authors: Chufa Zheng, Yaokui Huang, E. Xie, Dejin Xie, Yunheng Peng, Xiaozhong Wang

Published in: Surgical Endoscopy | Issue 6/2017

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Abstract

Background

Common bile duct (CBD) stone is one of the most common diseases among elderly people. In recent decades, there are numerous studies regarding the safety and efficacy of laparoscopic common bile duct exploration (LCBDE). Elderly patients are often regarded as high-risk patients because they are more likely to present with age-specific deterioration of organ function and coexisting chronic diseases, which may reduce their tolerance of laparoscopic surgery. Although laparoscopic surgery for choledocholithiasis is now widely accepted as the treatment for CBD stone, its appropriateness for the treatment of elderly patients or those with coexisting high-risk patients has not been well established. Therefore, the objective of this paper is to analyze the safety and efficacy of LCBDE in elderly patients.

Methods

Between January 2012 and November 2015, 376 patients underwent LCBDE in our center. Based on their ages, they were divided into two groups, and a retrospective study was performed. By making comparisons between younger group who were younger than 70 years (n = 253) and elderly group who were 70 years old or older (n = 123), the demographics, clinical characteristics, laboratory data, operative parameters and outcomes were analyzed.

Results

Before operation, elderly patients had more coexisting chronic diseases and risk factors, such as arterial hypertension, heart diseases, pulmonary diseases and previous abdominal surgery (P < 0.05). In both groups, LCBDE was equally successful with a high clearance rate (100 % in elderly patients vs. 98.8 % in younger group, P = 0.554). Besides, the operating time, intraoperative blood loss, postoperative hospital stay, total costs and overall complication showed no significant difference between two groups (P > 0.05). There was no major bile duct injury or death in either group.

Conclusion

Although elderly patients are frequently confronted with coexisting disorders, LCBDE can be considered as a safe and effective technique in choledocholithiasis treatment for elderly patients.
Literature
1.
Murray CJL, Barber RM, Foreman KJ, Ozgoren AA, Abd-Allah F, Abera SF, Aboyans V, Abraham JP, Abubakar I, Abu-Raddad LJ (2015) Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990–2013: quantifying the epidemiological transition. Lancet (London, England) 386:2145–2191CrossRef
2.
Hungness ES, Soper NJ (2006) Management of common bile duct stones. J Gastrointest Surg 10:612–619CrossRefPubMed
3.
Palermo M, Duza G, Caviglia ML, De Innocentis N, Egan P, Fiscella G, Moran M, Prieto J, Sousa M, Garcia R (2015) Treatment of bile duct stones by laparoscopy, endoscopy or combined approaches. Acta Gastroenterol Latinoam 45:90–96PubMed
4.
Costi R, DiMauro D, Mazzeo A, Boselli AS, Contini S, Violi V, Roncoroni L, Sarli L (2007) Routine laparoscopic cholecystectomy after endoscopic sphincterotomy for choledocholithiasis in octogenarians: Is it worth the risk? Surg Endosc 21:41–47CrossRefPubMed
5.
Weber DM (2003) Laparoscopic surgery: an excellent approach in elderly patients. Arch Surg 138:1083–1088CrossRefPubMed
6.
Grubnik VV, Tkachenko AI, Ilyashenko VV, Vorotyntseva KO (2012) Laparoscopic common bile duct exploration versus open surgery: comparative prospective randomized trial. Surg Endosc 26:2165–2171CrossRefPubMed
7.
Schreurs WH, Juttmann JR, Stuifbergen WN, Oostvogel HJ, van Vroonhoven TJ (2002) Management of common bile duct stones: selective endoscopic retrograde cholangiography and endoscopic sphincterotomy: short- and long-term results. Surg Endosc 16:1068–1072CrossRefPubMed
8.
Keizman D, Ish Shalom M, Konikoff FM (2006) Recurrent symptomatic common bile duct stones after endoscopic stone extraction in elderly patients. Gastrointest Endosc 64:60–65CrossRefPubMed
9.
Stromberg C, Nilsson M (2011) Nationwide study of the treatment of common bile duct stones in Sweden between 1965 and 2009. Br J Surg 98:1766–1774CrossRefPubMed
10.
Baucom RB, Feurer ID, Shelton JS, Kummerow K, Holzman MD, Poulose BK (2016) Surgeons, ERCP, and laparoscopic common bile duct exploration: Do we need a standard approach for common bile duct stones? Surg Endosc 30:414–423CrossRefPubMed
11.
Koc B, Karahan S, Adas G, Tutal F, Guven H, Ozsoy A (2013) Comparison of laparoscopic common bile duct exploration and endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy for choledocholithiasis: a prospective randomized study. Am J Surg 206:457–463CrossRefPubMed
12.
Overby DW, Apelgren KN, Richardson W, Fanelli R (2010) SAGES guidelines for the clinical application of laparoscopic biliary tract surgery. Surg Endosc 24:2368–2386CrossRefPubMed
13.
Kenny R, Richardson J, McGlone ER, Reddy M, Khan OA (2014) Laparoscopic common bile duct exploration versus pre or post-operative ERCP for common bile duct stones in patients undergoing cholecystectomy: Is there any difference? Int J Surg (London, England) 12:989–993CrossRef
14.
Aawsaj Y, Light D, Horgan L (2016) Laparoscopic common bile duct exploration: 15-year experience in a district general hospital. Surg Endosc 30:2563–2566CrossRefPubMed
15.
Mangla V, Chander J, Vindal A, Lal P, Ramteke VK (2012) A randomized trial comparing the use of endobiliary stent and T-tube for biliary decompression after laparoscopic common bile duct exploration. Surg Laparosc Endosc Percutan Tech 22:345–348CrossRefPubMed
16.
Gronroos JM (2011) Clinical success of ERCP procedures in nonagenarian patients with bile duct stones. Minim Invasive Ther Allied Technol 20:146–149CrossRefPubMed
17.
Dasari BV, Tan CJ, Gurusamy KS, Martin DJ, Kirk G, McKie L, Diamond T, Taylor MA (2013) Surgical versus endoscopic treatment of bile duct stones. Cochrane Database Syst Rev 12:Cd003327
18.
Paganini AM, Feliciotti F, Guerrieri M, Tamburini A, Campagnacci R, Lezoche E (2002) Laparoscopic cholecystectomy and common bile duct exploration are safe for older patients. Surg Endosc 16:1302–1308CrossRefPubMed
19.
Lee A, Min SK, Park JJ, Lee HK (2011) Laparoscopic common bile duct exploration for elderly patients: as a first treatment strategy for common bile duct stones. J Korean Surg Soc 81:128–133CrossRefPubMedPubMedCentral
20.
Parra-Membrives P, Martinez-Baena D, Lorente-Herce JM, Jimenez-Vega J (2014) Laparoscopic common bile duct exploration in elderly patients: Is there still a difference? Surg Laparosc Endosc Percutan Tech 24:e118–e122CrossRefPubMed
21.
Ding G, Cai W, Qin M (2014) Single-stage versus two-stage management for concomitant gallstones and common bile duct stones: a prospective randomized trial with long-term follow-up. J Gastrointest Surg 18:947–951CrossRefPubMed
22.
Lyass S, Phillips EH (2006) Laparoscopic transcystic duct common bile duct exploration. Surg Endosc 20(Suppl 2):S441–S445CrossRefPubMed
23.
24.
Hua J, Lin S, Qian D, He Z, Zhang T, Song Z (2015) Primary closure and rate of bile leak following laparoscopic common bile duct exploration via choledochotomy. Dig Surg 32:1–8CrossRefPubMed
25.
Vindal A, Chander J, Lal P, Mahendra B (2015) Comparison between intraoperative cholangiography and choledochoscopy for ductal clearance in laparoscopic CBD exploration: a prospective randomized study. Surg Endosc 29:1030–1038CrossRefPubMed
26.
Podda M, Polignano FM, Luhmann A, Wilson MS, Kulli C, Tait IS (2016) Systematic review with meta-analysis of studies comparing primary duct closure and T-tube drainage after laparoscopic common bile duct exploration for choledocholithiasis. Surg Endosc 30:845–861CrossRefPubMed
27.
Dong ZT, Wu GZ, Luo KL, Li JM (2014) Primary closure after laparoscopic common bile duct exploration versus T-tube. J Surg Res 189:249–254CrossRefPubMed
28.
Chander J, Vindal A, Lal P, Gupta N, Ramteke VK (2011) Laparoscopic management of CBD stones: an Indian experience. Surg Endosc 25:172–181CrossRefPubMed
Metadata
Title
Laparoscopic common bile duct exploration: a safe and definitive treatment for elderly patients
Authors
Chufa Zheng
Yaokui Huang
E. Xie
Dejin Xie
Yunheng Peng
Xiaozhong Wang
Publication date
01-06-2017
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 6/2017
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-016-5257-3

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