Laparoscopic transcystic approach with micro-incision of the cystic duct confluence in common bile duct exploration for choledocholithiasis in elderly patients

Abstract

Objective To investigate the application value of laparoscopic transcystic approach with micro-incision of the cystic duct confluence in common bile duct exploration (LTM-CBDE) for choledocholithiasis in elderly patients. Methods Clinical data of 142 elderly patients with choledocholithiasis in Beijing Hospital between June 2007 and June 2015 were retrospectively analyzed. There were 83 males and 59 females, aged (68±4) years old on average.The informed consents of all patients were obtained and the local ethical committee approval was received. The patients were divided into three groups according to the different surgical procedures: the LTM-CBDE group (n=62), laparoscopic common bile duct exploration group (LCBDE group, n=49) and open common bile duct exploration group (open surgery group, n=31). The operation time and postoperative length of hospital stay among three groups were compared using one way analysis of variance and LSD-t test. The rate was compared using Chi-square test. Results All stones were completely removed in three groups and no residual stone was observed. The operation time in the LTM-CBDE group was (155±11) min, which was significantly shorter than (166±10) min in the LCBDE group (LSD-t=-5.043, P<0.05). The postoperative length of hospital stay in the LTM-CBDE group was (5.7±1.1) d , which was significantly shorter than (7.3±1.7) d in the LCBDE group and (8.3±1.9) d in the open surgery group (LSD-t=-5.448, -7.724; P<0.05). The overall incidence of postoperative complications in the LTM-CBDE, LCBDE and open surgery groups was respectively 18% (11/62), 18% (9/49) and 42% (13/31). The overall incidence of postoperative complications in the LTM-CBDE group was significantly lower than that in the open surgery group (χ2=7.777, P<0.05). The incidence of postoperative infection of incision in the LTM-CBDE group was 2%, significantly lower than 13% in the open surgery group (χ2=5.072, P<0.05). No death was observed during the perioperative period. One case of common bile duct stone recurrence was observed respectively in the LTM-CBDE group and LCBDE group during the follow-up, and both were cured by retrograde cholangiopancreatography (ERCP). Conclusions LTM-CBDE is a safe and effective treatment for elderly patients with choledocholithiasis with the advantages of short operation time, rapid recovery and less postoperative complications. Key words: Choledocholithiasis; Laparoscopes; Aged; Perioperative period; Postoperative complications