Laparoscopic common bile duct exploration; a preferential pathway for elderly patients. (June 2018)

• Record Type: Journal Article
• Authors: Platt, T.E.; Smith, K.; Sinha, S.; Nixon, M.; Srinivas, G.; Johnson, N.; Andrews, S.
• Is Part Of: Annals of medicine and surgery. Volume 30(2018)
• Page Start: 13
• Page End: 17
• Publication Date: 2018-06
• Subjects: Laparoscopic common bile duct exploration -- Choledocholithiasis -- Gallstones -- Elderly patients -- Choledochoscopy; Surgery -- Periodicals; Medicine -- Periodicals; General Surgery -- Periodicals; Education, Medical -- Periodicals; Periodicals; 617
• DOI: 10.1016/j.amsu.2018.03.044
• Languages: English
• ISSNs: 2049-0801

Abstract

Abstract: Background: Laparoscopic common bile duct exploration (LCBDE) has emerged as a recommended alternative to endoscopic retrograde cholangiopancreatography (ERCP) for the management of choledocholithiasis. However, its use in the elderly has been limited, and evidence of its safety and efficacy in these patients is yet to be established. This study describes our experience of LCBDE in elderly patients, analysing the safety and efficacy of this technique in comparison to younger patients. Methods: All patients undergoing laparoscopic cholecystectomy (LC) with LCBDE for choledocholithiasis in our unit between January 2015 and January 2017 were included. Data pertaining to patient demographics, comorbidities, investigations, operative technique and outcomes were analysed. Patients were divided into 2 groups based on age (Group A:<65 years vs Group B: >/ = 65 years) for comparative analysis. Results: 124 patients (Group A: 65, Group B: 59) were included. Group B were more co-morbid and had a higher ASA grade than Group A. However, there was no significant difference between groups in rates of conversion to open or complications, including bile leak (3.1% vs 5.1%, p = 0.67), retained stone (4.6% vs 1.7%, p = 0.62), or complications according to Clavien-Dindo classification (p = 0.78). Re-intervention rates were also similar between groups (7.7% vs 3.4%, p = 0.44 and 3.1% vs 3.4%, p = 1.0 respectively), as was length of stay. Conclusion: Despite higher frequency of comorbidities and ASA grade, LCBDE in elderly patients is safe and effective, and has similar outcomes to younger patients. Therefore elderly patients with choledocholithiasis should be offered LCBDE as an alternative to ERCP. Highlights: Laparoscopic common bile duct exploration in elderly patients is safe despite comorbidities and higher ASA grades than younger patients. Elderly patients have similar rates of operative success, conversion to open, complications, length of stay and readmission to younger patients. Laparoscopic common bile duct exploration following intra-operative bile duct imaging without pre-operative imaging is safe and reliable.