Comparison of laparoscopic common bile duct exploration plus cholecystectomy and endoscopic retrograde cholangiopancreatography followed by laparoscopic cholecystectomy for elderly patients with common bile duct stones and gallbladder stones

Abstract

BackgroundCommon bile duct (CBD) stones commonly occur in cholecystectomy cases. Management options include laparoscopic common bile duct exploration (LCBDE) or endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC). While ERCP is mature, it has complications, and LCBDE is a proven alternative. This study evaluates the safety and efficacy of these treatments in elderly individuals aged 70 and older. MethodA retrospective study from January 2015 to July 2022 included 160 elderly patients (aged 70 and older) diagnosed with cholelithiasis and choledocholithiasis. Patients were divided into single-stage (LCBDE, n = 80) or two-stage (ERCP followed by LC, n = 80) treatment groups. Data collected encompassed comorbidities, symptoms, bile duct clearance, postoperative complications and long-term outcome for systematic analysis. ResultWe analyzed 160 patients treated for CBD stones, comparing single-stage and twostage groups. The one-stage group had more female patients (57.5% vs. 37.5%) and a higher mean age (80.55 ± 7 years). ASA classification, Charlson Comorbidity Index, and laboratory findings were similar. Pancreatitis and cholangitis occurred post-ERCP in the two-stage group. Stone clearance rates (92.35% vs. 95%) and biliary leakage incidence (7.5% vs. 3%) were similar, as were post-operative complications and longterm recurrence rates (13% vs. 12.5%). ConclusionIn conclusion, our research indicates that both the combination of LCBDE and LC and the sequence of ERCP followed by LC are equally efficient and secure when treating common bile duct stones in elderly patients. Consequently, the single-stage procedure may be considered the preferred treatment approach for this demographic.