Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Surgical Endoscopy
Published in: Surgical Endoscopy 4/2020

01-04-2020 | Endoscopic Retrograde Cholangiopancreatography | Review Article

Laparoscopic common bile duct exploration for elderly patients with choledocholithiasis: a systematic review and meta-analysis

Authors: Jisheng Zhu, Shuju Tu, Zhengjiang Yang, Xiaowei Fu, Yong Li, Weidong Xiao

Published in: Surgical Endoscopy | Issue 4/2020

Login to get access

Abstract

Background

Laparoscopic common bile duct exploration (LCBDE) has been becoming more and more popular in patients with symptomatic choledocholithiasis. However, the safety and effectiveness of LCBDE in elderly patients with choledocholithiasis is still uncertain. This meta-analysis is aimed to appraise the safety and feasibility of LCBDE for elderly patients with choledocholithiasis.

Materials and methods

Studies comparing elderly patients and younger patients who underwent LCBDE for common bile duct stone were reviewed and collected from the PubMed, Medline, EMBASE, and Cochrane Library. Primary outcomes were stone clearance rate, overall complication rate, and mortality rate. Secondary outcomes were operative time, conversion rate, pulmonary complication, bile leakage, reoperation, residual stone rate, and recurrent stone rate.

Results

Nine studies, including two prospective studies and seven retrospective studies, met the inclusion criteria. There were 2004 patients in this meta-analysis, including 693 elderly patients and 1311 younger patients. There was no statistically significant difference between elderly patients and younger patients regarding stone clearance rate (OR 0.73; 95% CI 0.42–1.26; p = 0.25), overall complication rate (OR 1.31; 95% CI 0.94–1.82; p = 0.12), and mortality rate (OR 2.80; 95% CI 0.82–9.53; p = 0.10). Similarly, the operative time, conversion rate, bile leakage, reoperation, residual stone rate, and recurrent stone rate showed no significant difference between two groups (p > 0.05). While elderly patients showed high risk for pulmonary complication (OR 4.41; 95% CI 1.78–10.93; p = 0.001) compared with younger patients.

Conclusion

Although there is associated with higher pulmonary complication, LCBDE is still considered as a safe and effective treatment for elderly patients with choledocholithiasis.
Literature
1.
United Nations (2017) World population prospects: key findings & advance tables, 2017 revision. UN Department of Economic and Social Affairs, Population Division, New York
2.
Lee HM, Min SK, Lee HK (2014) Long-term results of laparoscopic common bile duct exploration by choledochotomy for choledocholithiasis: 15-year experience from a single center. Ann Surg Treat Res 86:1–6CrossRefPubMedPubMedCentral
3.
Hungness ES, Soper NJ (2006) Management of common bile duct stones. J Gastrointest Surg 10:612–619CrossRefPubMed
4.
Zhu HY, Xu M, Shen HJ, Yang C, Li F, Li KW, Shi WJ, Ji F (2015) A meta-analysis of single-stage versus two-stage management for concomitant gallstones and common bile duct stones. Clin Res Hepatol Gastroenterol 39:584–593CrossRefPubMed
5.
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
6.
Carr-Locke DL (2002) Therapeutic role of ERCP in the management of suspected common bile duct stones. Gastrointest Endosc 56:S170–S174CrossRefPubMed
7.
Mitchell RM, O’Connor F, Dickey W (2003) Endoscopic retrograde cholangiopancreatography is safe and effective in patients 90 years of age and older. J Clin Gastroenterol 36:72–74CrossRefPubMed
8.
Jinfeng Z, Yin Y, Chi Z, Junye G (2016) Laparoscopic management after failed endoscopic stone removal in nondilated common bile duct. Int J Surg 29:49–52CrossRefPubMed
9.
Koc B, Adas G, Karahan S (2014) Use of laparoscopic common bile duct exploration for failed endoscopic bile duct stone extractions. Minerva Chir 69:209–215PubMed
10.
Zhou Y, Wu XD, Fan RG, Zhou GJ, Mu XM, Zha WZ, Jia J (2014) Laparoscopic common bile duct exploration and primary closure of choledochotomy after failed endoscopic sphincterotomy. Int J Surg 12:645–648CrossRefPubMed
11.
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
12.
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
13.
Parra-Membrives P, Martinez-Baena D, Lorente-Herce JM, Jiménez-Vega J (2014) Laparoscopic common bile duct exploration in elderly patients: is there still a difference? Surg Laparosc Endosc Percutan Tech 24:e118–e122CrossRefPubMed
14.
Bove A, Di Renzo RM, Palone G, D'Addetta V, Caldararo F, Antonopulos C, Panaccio P, Chiarini S, Bongarzoni G (2014) Which differences do elderly patients present in single-stage treatment for cholecysto-choledocholithiasis? Int J Surg 12:S160–S163CrossRefPubMed
15.
16.
Wang B, Ding YM, Nie YG, Zhang AM, Wang P, Wang WX (2014) The clinical evaluation of laparoscopic transcystic duct common bile duct exploration in elderly choledocholithiasis. Hepatogastroenterology 61:892–896PubMed
17.
Zhu JG, Guo W, Han W, Zhang ZT (2017) Laparoscopic transcystic common bile duct exploration in the elderly is as effective and safe as in younger patients. J Laparoendosc Adv Surg Tech A 27:48–52CrossRefPubMed
18.
Zheng C, Huang Y, Xie E, Xie D, Peng Y, Wang X (2017) Laparoscopic common bile duct exploration: a safe and definitive treatment for elderly patients. Surg Endosc 31:2541–2547CrossRefPubMed
19.
Liu WS, Jiang Y, Zhang D, Shi LQ, Sun DL (2018) Laparoscopic common bile duct exploration is a safe and effective strategy for elderly patients. Surg Innov 25:465–469CrossRefPubMed
20.
Platt TE, Smith K, Sinha S, Nixon M, Srinivas G, Johnson N, Andrews S (2018) Laparoscopic common bile duct exploration; a preferential pathway for elderly patients. Ann Med Surg (Lond) 30:13–17CrossRef
21.
Zhou Y, Zha WZ, Fan RG, Jiang GQ, Wu XD (2019) Two-stage versus single-stage procedure for the management of cholecystocholedocholithiasis in elderly patients: a retrospectively cohort study. Rev Esp Enferm Dig 111:176–181PubMed
22.
23.
Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196CrossRefPubMed
24.
Grubnik VV, Tkachenko A, Ilyashenko VV, Vorotyntseva KO (2012) Laparoscopic common bile duct exploration versus open surgery: comparative prospective randomized trial. Surg Endosc 26:2165–2171CrossRefPubMed
25.
Halawani HM, Tamim H, Khalifeh F, Mailhac A, Taher A, Hoballah J, Jamali FR (2017) Outcomes of laparoscopic vs open common bile duct exploration: analysis of the NSQIP database. J Am Coll Surg 224:833–840CrossRefPubMed
26.
Alexakis N, Connor S (2012) Meta-analysis of one- vs. two-stage laparoscopic/endoscopic management of common bile duct stones. HPB (Oxford) 14:254–259CrossRef
27.
Williams E, Beckingham I, El Sayed G, Gurusamy K, Sturgess R, Webster G, Young T (2017) Updated guideline on the management of common bile duct stones (CBDS). Gut 66:765–782CrossRefPubMed
28.
Chan DS, Jain PA, Khalifa A, Hughes R, Baker AL (2014) Laparoscopic common bile duct exploration. Br J Surg 101:1448–1452CrossRefPubMed
29.
Zhu J, Sun G, Hong L, Li X, Li Y, Xiao W (2018) Laparoscopic common bile duct exploration in patients with previous upper abdominal surgery. Surg Endosc 32:4893–4899CrossRefPubMed
30.
Ito Y, Tsujino T, Togawa O, Yamamoto N, Isayama H, Nakata R, Kawabe T, Omata M (2008) Endoscopic papillary balloon dilation for the management of bile duct stones in patients 85 years of age and older. Gastrointest Endosc 68:477–482CrossRefPubMed
31.
Obana T, Fujita N, Noda Y, Kobayashi G, Ito K, Horaguchi J, Koshita S, Kanno Y, Yamashita Y, Kato Y, Ogawa T (2010) Efficacy and safety of therapeutic ERCP for the elderly with choledocholithiasis: comparison with younger patients. Intern Med 49:1935–1941CrossRefPubMed
32.
33.
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
34.
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
35.
Xia HT, Liang B, Liu Y, Yang T, Zeng JP, Dong JH (2016) Ultrathin choledochoscope improves outcomes in the treatment of gallstones and suspected choledocholithiasis. Expert Rev Gastroenterol Hepatol 10:1409–1413CrossRefPubMed
36.
Nassar AH, Mirza A, Qandeel H, Ahmed Z, Zino S (2016) Fluorocholangiography: reincarnation in the laparoscopic era-evaluation of intra-operative cholangiography in 3635 laparoscopic cholecystectomies. Surg Endosc 30:1804–1811CrossRefPubMed
37.
Xia HT, Liu Y, Jiang H, Yang T, Liang B, Zeng JP, Dong JH (2018) A novel laparoscopic transcystic approach using an ultrathin choledochoscope and holmium laser lithotripsy in the management of cholecystocholedocholithiasis: an appraisal of their safety and efficacy. Am J Surg 215:631–635CrossRefPubMed
38.
Lei J, Wang J, Li Q, Wu P, Yuan R, Zhu H, Zou S, Shao J, Fang L (2016) Laparoscopic transcystic common bile duct exploration: T-shaped incision of cystic duct with FREDDY laser lithotripsy. J Laparoendosc Adv Surg Tech A 8:646–651CrossRef
Metadata
Title
Laparoscopic common bile duct exploration for elderly patients with choledocholithiasis: a systematic review and meta-analysis
Authors
Jisheng Zhu
Shuju Tu
Zhengjiang Yang
Xiaowei Fu
Yong Li
Weidong Xiao
Publication date
01-04-2020
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 4/2020
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-020-07394-x

Other articles of this Issue 4/2020

Surgical Endoscopy 4/2020 Go to the issue

OriginalPaper

HYPerspectral Enhanced Reality (HYPER): a physiology-based surgical guidance tool

OriginalPaper

The recurrent bleeding risk of a Forrest IIc lesion at the second-look endoscopy can be indicated by high Rockall scores ≥ 6

2019 SAGES Oral

Is that ‘floppy’ fundoplication tight enough?

OriginalPaper

A successful clinical pathway protocol for minimally invasive esophagectomy

OriginalPaper

Outcomes of laparoscopic hiatal hernia repair based on surgical specialty: thoracic versus general surgeons

2019 SAGES Oral

Gastrectomy versus stomach left in situ with Roux-en-Y reconstruction for the treatment of gastroparesis