Which differences do elderly patients present in single-stage treatment for cholecysto-choledocholithiasis?

Area of Science:

• Gastroenterology
• Surgical Innovation
• Geriatric Medicine

Background:

• Symptomatic gallstones coexist with common bile duct stones in about 10% of patients.
• A single-stage procedure can simultaneously address both gallbladder and bile duct stones.
• Evaluating this approach in elderly patients is crucial due to potential increased risks.

Purpose of the Study:

• To assess the effectiveness of a single-stage procedure for gallbladder and bile duct stones in elderly patients.
• To compare outcomes between younger and older patient groups undergoing this treatment.
• To identify differences in technique efficacy based on patient age.

Main Methods:

• Retrospective analysis of 1540 patients with gallbladder stones from January 2008 to December 2013.
• Focus on 152 patients with concomitant bile duct stones, 150 treated in a single stage.
• Comparison of two groups: Group A (under 65) and Group B (65 and older), analyzing sex, ASA score, complications, and hospital stay.

Main Results:

• No intra-operative mortality; one late death in Group B due to unrelated comorbidities.
• Elderly patients (Group B) had significantly higher ASA scores, post-operative complications (18.1% vs 6%), and hospital stays (9.5 vs 4.1 days).
• Overall success rates were similar (90% in Group B vs 94% in Group A), but bile duct clearance methods differed: trans-cystic clearance (TC-CBDE) was less successful in older patients (51%) compared to younger ones (90%), necessitating laparo-endoscopic rendez-vous (RV-IOERC) in 49% of elderly cases.

Conclusions:

• Single-stage treatment for gallbladder and bile duct stones is safe and effective in elderly patients.
• While overall success is comparable, technique selection for bile duct clearance requires age-specific consideration.
• Trans-cystic clearance is less effective in older adults, with laparo-endoscopic rendez-vous being a necessary alternative.