Comparison of one-stage laparoscopic common bile duct exploration plus cholecystectomy and two-stage endoscopic sphincterotomy plus laparoscopic cholecystectomy for concomitant gallbladder and common bile duct stones in patients over 80 years old

Seung Jae Lee; In Seok Choi; Ju Ik Moon; Young Woo Choi; Ki-Hyun Ryu

doi:10.7602/jmis.2022.25.1.11

Comparison of one-stage laparoscopic common bile duct exploration plus cholecystectomy and two-stage endoscopic sphincterotomy plus laparoscopic cholecystectomy for concomitant gallbladder and common bile duct stones in patients over 80 years old

J Minim Invasive Surg. 2022 Mar 15;25(1):11-17. doi: 10.7602/jmis.2022.25.1.11.

Authors

Seung Jae Lee¹, In Seok Choi¹, Ju Ik Moon¹, Young Woo Choi^{2

3}, Ki-Hyun Ryu^{2

3}

Affiliations

¹ Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea.
² Division of Gastroenterology, Department of Internal Medicine, Konyang University Hospital. Konyang University College of Medicine, Daejeon, Korea.
³ Myunggok Medical Research Center, Konyang University College of Medicine, Daejeon, Korea.

Abstract

Purpose: This study was performed to compare the safety and efficacy of one-stage laparoscopic common bile duct exploration (LCBDE) plus laparoscopic cholecystectomy (LC) with those of endoscopic sphincterotomy (EST) plus LC for concomitant gallbladder (GB) and common bile duct (CBD) stones in elderly patients.

Methods: This single-center retrospective study reviewed the medical records of patients aged >80 years who were diagnosed with concomitant GB and CBD stones between January 2010 and December 2020.

Results: Of the 137 patients included in this study, 46 underwent one-stage LCBDE + LC and 91 underwent two-stage EST + LC. The frequency of previous gastrectomy (23.9% vs. 5.5%, p = 0.002) and multiple stones (76.1% vs. 49.5%, p = 0.003) was higher in the LCBDE + LC group than in the EST + LC group. Further, patients in LCBDE + LC group had larger CBD stones (11.9 mm vs. 6.0 mm, p < 0.001). There were no significant differences in the clearance (91.3% vs. 95.6%, p = 0.311) and recurrence (4.3% vs. 8.8%, p = 0.345) rates between the groups. The incidence of posttreatment overall complications (17.4% vs. 22.0%, p = 0.530) and total hospital stay (12.7 days vs. 11.7 days, p = 0.339) were similar in the two groups.

Conclusion: One-stage LCBDE + LC is a safe and effective treatment for concomitant GB and CBD stones, even in elderly patients, and may be considered as the first treatment option in elderly patients with previous gastrectomy, multiple large (≥ 15 mm) CBD stones, or inability to cooperate with endoscopic procedures.

Keywords: Common bile duct; Endoscopic sphincterotomy; Gallstones; Laparoscopic cholecystectomy.