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

Abstract

Abstract Background For patients with choledocholithiasis, laparoscopic common bile duct exploration (LCBDE) is preferred over open surgery. Whether primary closure of common bile duct (CBD) should be performed on completion of choledochotomy and corresponding indications for primary closure of common bile duct are still controversial topics. This study was accomplished to evaluate safety and feasibility of primary closure of CBD among elderly patients (≥ 70 years) after LCBDE. Methods Patients with choledocholithiasis who had undergone LCBDE with primary closure of CBD between July 2014 and December 2020 were retrospectively reviewed. Included patients were assigned into two groups (group A: ≥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. Results The mean operative time for group A was 176.59 minutes (± 68.950) while the operative time for group B was 167.64 minutes (± 69.635 ) (P = 0.324). The mean hospital stay after surgery for group A was 8.43 days (± 4.440) while that for group B was 8.30 days (± 5.203) (P = 0.849). 3 patients in group A experienced bile leakage while bile leakage occurred to 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 ones in group B experienced stone recurrence (2.5% VS 0.9%, P = 0.612). 1 patient in group A experienced stenosis of CBD while stenosis of CBD occurred to 5 ones in group B (1.3% VS 2.2%, P = 0.937). Conclusions Simultaneous closure of CBD upon completion of LCBDE could be safely performed among patients ≥ 70 years.