A two-stage versus single-stage procedure for the management of cholecysto-choledocholithiasis in elderly patients: a retrospectively cohort study

Abstract

Background: there is an increasing incidence rate of cholecysto-choledocholithiasis associated with the increasing proportion of senile individuals. Methods: a total of 100 elderly patients (over 80 years of age) suffering both from cholelithiasis and choledocholithiasis were retrospectively studied from January 2010 to December 2016. Patients were scheduled for either a single-stage or two-stage procedure. The LCBDE group (n = 54) included cases that underwent a single stage procedure of laparoscopic exploration of the common bile duct combined with cholecystectomy. The ERCP/EST group (n = 46) included cases that underwent a two stage procedure of preoperative endoscopic retrograde cholangiopancreaticography with endoscopic sphincterotomy followed by cholecystectomy. Comorbidity conditions, presenting symptoms, bile duct clearance, length of hospital stay and the frequency of procedural, postoperative and long-term complications were recorded. Results: the LCBDE group had a higher stones clearance rate than the ERCP/EST group (100.0% vs 89.1%, p < 0.05). Postoperative complications and hospitalization length were comparable in the two groups (p > 0.05). There were more procedural complications in the ERCP/EST group than in the LCBDE group (10.8% vs 0%, p < 0.05). Furthermore, a patient in the ERCP/EST group died due to duodenal perforation. More patients in the ERCP/EST group experienced long-term complications than those in the LCBDE group (23.9% vs 3.7%, p < 0.05) during a mean follow-up period of 28.4 months. Conclusions: the single-stage procedure is a safe and effective technique for elderly patients with cholecysto-choledocholithiasis. LCBDE provides a good stone clearance rate with few long term complications.

Efficacy and safety of double endoscopy combined with exploration in the treatment of elderly patients with cholecystolithiasis complicated with choledocholithiasis

“…In the present study, the overall incidence of postoperative complications was 15.9% in the elderly group and 3.9% in the young and middle-aged group, including surgical site infections, bleeding, bile duct injuries, and respiratory issues, and the difference was statistically significant. Zhang et al [ 22 ] reported an overall incidence of complications of 18.5% in elderly patients undergoing LC + LCBDE, and Zhou et al [ 8 ]reported an incidence of 14.8%, which was consistent with the findings of the present study. In the present study, pulmonary infection was the major and most common complication in these elderly patients.…”

“…The currently known methods include ERCP + LC and LC + LCBDE [ 3 – 7 ]. However, ERCP is associated with postoperative complications due to a damaged SO [ 8 , 9 ] and increased difficulties in selective LC. Accordingly, LCBDE combined with LC can enable surgeons to address the two conditions at the same time while patients are anaesthetised only once, maximising the interests of patients with a higher success rate and lower postoperative recurrence.…”

Comparison of one-stage laparoscopic common bile duct exploration plus cholecystectomy and two-stage endoscopic sphincterotomy plus laparoscopic cholecystectomy for concomitant gallbladder and common bile duct stones in patients over 80 years old

“…However, this difference in the complication rates may be attributed to the fact that only studies that set the age limit as 65 or 70 years were included. The complication rate was similar to that reported in a previous study that included patients aged >80 years (14.8%) [23].…”

Near-infrared cholangiography can increase the chance of success in laparoscopic approaches to common bile duct stones, even with previous abdominal surgery

“…However, for common bile duct stones, it is still a matter for debate. An increasing number of studies describe the benefits of one-stage treatment for gallstones combined with CBD stones using minimally invasive surgery instead of ERCP combined with LC [ 19 , 20 ]. For patients with a history of previous gastrectomy with gastrojejunostomy, ERCP and LCBDE were both possible solutions for CBD stones [ 21 ].…”