Skip to main content
SpringerLink
Log in

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

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  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) 386:2145–2191

    Article  Google Scholar 

  2. Hungness ES, Soper NJ (2006) Management of common bile duct stones. J Gastrointest Surg 10:612–619

    Article  PubMed  Google Scholar 

  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 45:90–96

    PubMed  Google Scholar 

  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 21:41–47

    Article  CAS  PubMed  Google Scholar 

  5. Weber DM (2003) Laparoscopic surgery: an excellent approach in elderly patients. Arch Surg 138:1083–1088

    Article  PubMed  Google Scholar 

  6. Grubnik VV, Tkachenko AI, Ilyashenko VV, Vorotyntseva KO (2012) Laparoscopic common bile duct exploration versus open surgery: comparative prospective randomized trial. Surg Endosc 26:2165–2171

    Article  CAS  PubMed  Google Scholar 

  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 16:1068–1072

    Article  CAS  PubMed  Google Scholar 

  8. Keizman D, Ish Shalom M, Konikoff FM (2006) Recurrent symptomatic common bile duct stones after endoscopic stone extraction in elderly patients. Gastrointest Endosc 64:60–65

    Article  PubMed  Google Scholar 

  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 98:1766–1774

    Article  CAS  PubMed  Google Scholar 

  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 30:414–423

    Article  PubMed  Google Scholar 

  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 206:457–463

    Article  PubMed  Google Scholar 

  12. Overby DW, Apelgren KN, Richardson W, Fanelli R (2010) SAGES guidelines for the clinical application of laparoscopic biliary tract surgery. Surg Endosc 24:2368–2386

    Article  PubMed  Google Scholar 

  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) 12:989–993

    Article  CAS  Google Scholar 

  14. Aawsaj Y, Light D, Horgan L (2016) Laparoscopic common bile duct exploration: 15-year experience in a district general hospital. Surg Endosc 30:2563–2566

    Article  PubMed  Google Scholar 

  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 22:345–348

    Article  PubMed  Google Scholar 

  16. Gronroos JM (2011) Clinical success of ERCP procedures in nonagenarian patients with bile duct stones. Minim Invasive Ther Allied Technol 20:146–149

    Article  PubMed  Google Scholar 

  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

    Google Scholar 

  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 16:1302–1308

    Article  CAS  PubMed  Google Scholar 

  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 81:128–133

    Article  PubMed  PubMed Central  Google Scholar 

  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–e122

    Article  PubMed  Google Scholar 

  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 18:947–951

    Article  PubMed  Google Scholar 

  22. Lyass S, Phillips EH (2006) Laparoscopic transcystic duct common bile duct exploration. Surg Endosc 20(Suppl 2):S441–S445

    Article  PubMed  Google Scholar 

  23. Petelin JB (2003) Laparoscopic common bile duct exploration. Surg Endosc 17:1705–1715

    Article  CAS  PubMed  Google Scholar 

  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 32:1–8

    Article  PubMed  Google Scholar 

  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 29:1030–1038

    Article  PubMed  Google Scholar 

  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 30:845–861

    Article  PubMed  Google Scholar 

  27. Dong ZT, Wu GZ, Luo KL, Li JM (2014) Primary closure after laparoscopic common bile duct exploration versus T-tube. J Surg Res 189:249–254

    Article  PubMed  Google Scholar 

  28. Chander J, Vindal A, Lal P, Gupta N, Ramteke VK (2011) Laparoscopic management of CBD stones: an Indian experience. Surg Endosc 25:172–181

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Abhishek Kumar Patel and Huayin Zheng for careful revision of the manuscript.

Author information

Authors and Affiliations

  1. Department of General Surgery, the Affiliated Shantou Hospital of Sun Yat-sen University, Guangdong, 515000, China

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

Authors
  1. Chufa Zheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yaokui Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E. Xie
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dejin Xie
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yunheng Peng
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xiaozhong Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Xiaozhong Wang.

Ethics declarations

Disclosure

Chufa Zheng, Yaokui Huang, E Xie, Dejin Xie, Yunheng Peng, and Xiaozhong Wang have no conflict of interests to declare.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zheng, C., Huang, Y., Xie, E. et al. Laparoscopic common bile duct exploration: a safe and definitive treatment for elderly patients. Surg Endosc 31, 2541–2547 (2017). https://doi.org/10.1007/s00464-016-5257-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-016-5257-3

Keywords

Search

Navigation