Micro-incision of the cystic duct confluence in laparoscopic common bile duct exploration for choledocholithiasis in elderly patients

Abstract

Objective Common bile duct stones are common in elderly patients.The laparoscopic transcystic approach with micro-incision of the cystic duct confluence in common bile duct exploration (LTM-CBDE) is a modified laparoscopic transcystic approach.This study evaluated the safety and efficacy of LTM-CBDE in the elderly (≥65 years) patients with choledocholithiasis and compared the results in the elderly with those in younger patients. Methods In this retrospective analysis, 128 patients underwent LTM-CBDE from March 2007 to December 2013.The patients were divided into two groups: aged ≥65 years (n=50, the elderly group) versus aged <65 years (n=78, the younger group). The preoperative morbidity rate, American Society of Anesthesiologists (ASA) score, previous abdominal operations, operation time, postoperative hospital stay, open conversion rate, postoperative complication rate, residual stone rate, recurrence rate and mortality rate were compared between the both groups. Results The preoperative morbidity (41 vs.28) and ASA score (2.5±0.7 vs.1.8±0.6) were higher in the elderly group than in he younger group (χ2=26.063, t=-6.030, P=0.000, in both). No significant differences in previous abdominal operations, operation time, postoperative hospital stay, open conversion rate, postoperative complication rate, residual stone rate, recurrence rate and mortality rate (P>0.05) were found between the two groups from March 2007 to December 2013. Conclusions LTM-CBDE is a safe and effective treatment procedure for elderly patients with choledocholithiasis.For LTM-CBDE-suitable patients, we recommend LTM-CBDE as the treatment of choice. Key words: Choledocholithiasis; Biliary tract surgical procedures; Laparoscopy