Laparoscopic common bile duct exploration with primary closure could be safely performed among elderly patients with choledocholithiasis

BackgroundFor patients with choledocholithiasis, laparoscopic common bile duct exploration (LCBDE) is preferred over open surgery. Whether primary closure of the common bile duct (CBD) should be performed upon completion of choledochotomy remains unclear, and the corresponding indications for primary closure of the common bile duct have yet to be fully identified. This study was performed to evaluate the safety and feasibility of primary closure of CBD among elderly patients (& GE; 70 years) after LCBDE.MethodsPatients with choledocholithiasis who had undergone LCBDE with primary closure of the CBD between July 2014 and December 2020 were retrospectively reviewed. Included patients were assigned into two groups (Group A: & GE;70 years and Group B: <70 years) according to age. Group A was compared with Group B in terms of preoperative characteristics, intraoperative results and postoperative outcomes.ResultsThe mean operative time for Group A was 176.59 min (& PLUSMN; 68.950), while the mean operative time for Group B was 167.64 min (& PLUSMN; 69.635) (P = 0.324). The mean hospital stay after surgery for Group A was 8.43 days (& PLUSMN; 4.440), while that for Group B was 8.30 days (& PLUSMN; 5.203) (P = 0.849). Three patients in Group A experienced bile leakage, while bile leakage occurred in 10 patients in Group B (3.8% vs. 4.5%, P = 0.781). Group A was not significantly different from Group B in terms of postoperative complications and 30-day mortality except pneumonia (P = 0.016), acute cardiovascular event (P = 0.005) and ICU observation (P = 0.037). After a median follow-up time of 60 months, 2 patients in Group A and 2 patients in Group B experienced stone recurrence (2.5% vs. 0.9%, P = 0.612). One patient in Group A experienced stenosis of the CBD, while stenosis of the CBD occurred in 5 patients in Group B (1.3% vs. 2.2%, P = 0.937).ConclusionsPrimary closure of CBD upon completion of LCBDE could be safely performed among patients & GE; 70 years.

Automated summary

This study aimed to evaluate the safety and feasibility of primary closure of the common bile duct among elderly patients (≥70 years) after laparoscopic common bile duct exploration. The results showed that there were no significant differences in terms of operative time, hospital stay, postoperative complications, and stone recurrence between the group of patients aged ≥70 years and the group of patients aged <70 years.