Laparoscopic common bile duct exploration with primary closure is preferred for selected elderly individuals with choledocholithiasis.

Abstract

Laparoscopic common bile duct exploration with primary closure (LCBDE-PC) exhibits more benefits than other surgeries for patients with choledocholithiasis. It remains unclear whether it is feasible for and beneficial to elderly individuals. This study aimed to clarify and stratify elderly patients who would benefit from LCBDE-PC. A retrospective study of 1240 patients with choledocholithiasis who underwent laparoscopic procedures between 2011 and 2019 was conducted. Patients were divided into the young group (<65 years old, n=708) and the elderly group (≥65 years old, n=532). Perioperative outcomes were compared between the two groups. Laparoscopic common bile duct exploration with primary closure was successfully performed in 90.20% of the elderly and 94.20% of the young. No significant differences were observed between the two groups regarding reoperation, postoperative bile leakage, residual stones, drainage removal, and postoperative mortality. Compared with the young, the elderly had longer postoperative hospital stay (p=0.035) and delayed postoperative eating time (p=0.036) in the matched cohort. Independent risk factors for failed LCBDE-PC were preoperative pancreatitis (p=0.018), year of the surgeon's experience (p=0.008), preoperative C-reactive protein level (p=0.034), preoperative total bilirubin (p=0.021), impacted common bile duct (CBD) stones (p=0.006), blood loss (p=0.001), and edema of the CBD (p=0.001). A novel nomogram for predicting failed LCBDE-PC in elderly individuals exhibited a sufficient discriminative ability according to the estimated area under the curve (AUC) of 0.869 (95% CI: 0.817-0.921, p < 0.01). Laparoscopic common bile duct exploration with primary closure is safe, feasible, and effective for elderly individuals with choledocholithiasis. Elderly patients with a high risk of failed LCBDE-PC should be cautious of undergoing LCBDE-PC.