Laparoscopic cholecystectomy and common bile duct exploration are safe for older patients

Paganini, Alessandro M.; Feliciotti, F; Guerrieri, Mario; Tamburini, A.; Campagnacci, Roberto; Lezoche, Emanuele

doi:10.1007/s00464-001-8316-2

Cited by 29 publications

(25 citation statements)

References 21 publications

(34 reference statements)

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“…The other study on LCBDE in the elderly has a reported mortality rate of only 1.3%. 28 This further supports our view that LCBDE can be safely performed in the elderly.…”

Section: Discussionsupporting

confidence: 84%

“…To our knowledge, apart from this article, there is only one other study in the English literature looking specifically at LCBDE in the elderly. 28 In our study, there were 55 patients in the open group and 27 patients in the LCBDE group. All patients were over 70 years of age, and most were in ASA class II or III.…”

Section: Discussionmentioning

confidence: 76%

“…15 Of interest, the incidence of CBD stones is higher in the elderly; however, this procedure is not well studied in this group of patients. 16,17 There are also concerns regarding the safety of biliary tract surgery in elderly patients especially in the acute setting. …”

mentioning

confidence: 99%

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Common Bile Duct Exploration in an Elderly Asian Population

Shelat

Chia

Low

2015

International Surgery

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Common bile duct exploration (CBDE) is an accepted treatment for choledocholithiasis. This procedure is not well studied in the elderly population. Here we evaluate the results of CBDE in elderly patients (.70 years) and compare the open (group A) with the laparoscopic group (group B). A retrospective review was performed of elderly patients with proven common bile duct (CBD) stones who underwent CBDE from January 2005 to December 2009. There were 55 patients in group A and 33 patients in group B. Mean age was 77.6 years (70-91 years). Both groups had similar demographics, liver function tests, and stone size-12 mm (range, 5-28 mm). Patients who had empyema (n ¼ 9), acute cholecystitis (n ¼ 15), and those who had had emergency surgery (n ¼ 28) were more likely to be in group A (P , 0.05). The mean length of stay for group A was 11.7 6 7.3 days; for group B, 5.2 6 6.3 days; the complication rate was higher in group A (group A, 38.2%; group B, 8.5%; P ¼ 0.072). The overall complication and mortality rate was 29.5% and 3.4%, respectively. CBDE can be performed safely in the elderly with accepted morbidity and mortality. The laparoscopic approach is feasible and safe in elective setting even in the elderly.

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“…The other study on LCBDE in the elderly has a reported mortality rate of only 1.3%. 28 This further supports our view that LCBDE can be safely performed in the elderly.…”

Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 76%

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Common Bile Duct Exploration in an Elderly Asian Population

Shelat

Chia

Low

2015

International Surgery

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“…Although the outcome of one specific laparoscopic procedure in general surgery has been evaluated for different age groups [18,19], there is no such study in laparoscopic urology. The present study is an initial report comparing two different age groups for LRN.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic radical nephrectomy in the elderly

et al. 2004

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Authors from Innsbruck present their work in laparoscopic radical nephrectomy in elderly patients. They evaluated the outcome of this technique in patients over 75 years old and compared the results with a similar number of patients aged less than 75 years who had the same procedure. Despite more comorbid conditions in the older group the final outcome was equally as good as in the younger patients.Hormone‐refractory prostate cancer is becoming a matter of great concern, and authors from Paris describe their experience with a combination of docetaxel and zoledronic acid in this condition. In this early report, they found the use of these agents to be promising, and recommend the setting up of a prospective randomized trial.OBJECTIVETo evaluate the efficacy and outcome of laparoscopic radical nephrectomy (LRN) in patients aged >75 years, and to compare the results with those obtained from patients younger than this undergoing laparoscopic surgery for the same indication.PATIENTS AND METHODSFrom a retrospective review of 33 patients aged >75 years undergoing LRN, 28 were for tumour. A group of 28 consecutive patients aged <75 years undergoing laparoscopy for the same indication were used for comparison. The two groups were compared for American Society of Anesthesiology (ASA) physical status score, comorbidity, previous surgical history, operative duration, estimated blood loss, tumour size, complications during and after surgery, conversion rates, time to oral intake and drain removal, perioperative mortality and hospital stay.RESULTSOnly the initial ASA score was significantly higher for the older patients. All other variables before, during and after surgery were similar for both groups.CONCLUSIONSThe final outcome of laparoscopic surgery in elderly patients was as promising as in their younger counterparts. Therefore, elderly patients should not be excluded from LRN, even though they usually present with more comorbidities.

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“…In contrast, the mortality rate of surgery for stones in the common bile duct was 1.6–6.2% or even higher [7, 8, 9, 12]. Therefore, endoscopic treatment of common bile duct stones is the treatment of choice.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic Management of Common Bile Duct Stones Leaving the Gallbladder in situ

et al. 2004

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Background: Obstructive jaundice caused by stones is a common disorder, mostly managed by endoscopic sphincterotomy followed by cholecystectomy. The aim of this study was to evaluate whether or not clearance of the common bile duct alone is sufficient as treatment for patients with choledocholithiasis. Methods: A cohort with 447 patients with symptomatic cholecystocholedocholithiasis, undergoing endoscopic retrograde cholangiography (ERC) and if necessary sphincterotomy (ES). In 164 patients common bile duct stones were proven and treated endoscopically, without performing a subsequent cholecystectomy. All 164 patients were free of symptoms after the endoscopic intervention. This group of patients was compared with 78 patients who underwent cholecystectomy after endoscopic treatment of common bile duct stones. Patients were followed for 1–13 years after ERC and sphincterotomy results and complications were registered. Results: The ages of the 164 patients in the in situ group were significantly higher than in the cholecystectomy group and the ASA classification (American Society of Anesthesiologists) was significantly higher in the in situ patients. Mean follow-up was 70.9 months. Of the in situ patients 27 (16%) returned with biliary symptoms; 12 with common bile duct stones, three with cholangitis, and one with stenosis of Vater’s papilla. Eight patients returned with cholecystitis and 3 with symptomatic cholecystolithiasis. Thirteen patients underwent cholecystectomy and 11 were managed (also) endoscopically. Minor complications were 2 wound infections and 1 bleeding after cholecystectomy. Two patients (1%) died of abdominal sepsis due to cholecystitis. Of the patients who underwent cholecystectomy, 6 (7.6%) returned during follow-up. Three patients had common bile duct stones, 2 had cholangitis and 1 patient presented with papillostenosis. Three patients needed surgical common bile duct exploration and the other 3 were treated endoscopically. After reintervention, cardiopulmonary complications were observed in 1 patient. There was no related death. Conclusion: When common bile duct stones are treated successfully by endoscopic sphincterotomy and patients are free of symptoms, there is no need for routine prophylactic cholecystectomy.

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Laparoscopic cholecystectomy and common bile duct exploration are safe for older patients

Abstract: Elective laparoscopic CBD exploration is safe and effective. It may become the standard of care in both elderly and younger patients.

Cited by 29 publications

References 21 publications

Common Bile Duct Exploration in an Elderly Asian Population

Common Bile Duct Exploration in an Elderly Asian Population

Laparoscopic radical nephrectomy in the elderly

Endoscopic Management of Common Bile Duct Stones Leaving the Gallbladder in situ

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