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Laparoscopic cholecystectomy and common bile duct exploration are safe for older patients
A M Paganini1, F Feliciotti, M Guerrieri
1Clinica di Chirurgia Generale e Metodologia Chirurgica, Ospedale Umberto I degrees, Università di Ancona, Piazza Cappelli 1, 60121 Ancona, Italy. a.m.paganini@med.unian.it
Background:
Laparoscopic common bile duct (CBD) exploration is a well-established treatment option in dedicated centers. However, few data are available on the results in elderly patients.
Methods:
The outcome after laparoscopic CBD exploration in elderly patients (age <70 years) was compared with that in a concurrent control group of younger patients (age, <70 years).
Results:
There were 77 elderly patients in group A and 207 younger patients in group B. American Society of Anesthesiology (ASA) III and IV patients and prior abdominal operations were more frequent in group A (p <0.001). Two patients from each group underwent conversion to open surgery. There was no significant difference frequency of use between the transcystic and choledochotomy approaches, although the latter tended to be more frequent in the group A because of larger stones, (group A 53.4%; group B, 37.6%). Minor and major morbidity (group A, 12%; group B, 13.6%), rate of recurrent stones (group A, 1.3%; group B, 1.9%), and mortality (group A, 1.3%; group B, 0%) were not significantly different between the two groups. The single death in group A involved a patient with acute toxic cholangitis who underwent emergency surgery after multiple failed attempts at endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomy performed elsewhere. No CBD stenosis was observed at follow-up assessment.
Conclusions:
Elective laparoscopic CBD exploration is safe and effective. It may become the standard of care in both elderly and younger patients.