Efficacy of laparoscopic surgery in the treatment of elderly patients with choledocholithiasis and cholecystolithiasis

Objective To explore the efficacy and safety of laparoscopic cholecystectomy + laparoscopic common bile duct exploration (LC+LCBDE) in the treatment of elderly patients with choledocholithiasis and cholecystolithiasis. Methods Clinical data of 130 patients, aged 80 years and above and with choledocholithiasis and cholecystolithiasis, who were admitted in East China Hospital Affiliated to Fudan University from April 2011 to May 2017 were analyzed retrospectively. The informed consents of all patients were obtained and the local ethical committee approval was received. The patients were divided into LC+LCBDE group (laparoscopy group) and traditional laparotomy group (laparotomy group) according to different surgical procedure. There were 66 patients in laparoscopy group, including 38 males and 28 females, with an average age of (84±4) years. There were 64 patients in laparotomy group, including 30 males and 34 females, with an average age of (84±4) years. Perioperative indicators such as operation time and amount of bleeding between two groups were compared by t test, and the incidence of complications was compared by Chi-square test or Fisher's exact probability test. Results The operations of all the patients were performed successfully. In laparoscopy group, the operation time, postoperative first anus exhaust time and use time of analgesic medication were (105±44) min, (2.2±0.8) d and (2.4±1.3) d, which were significantly shorter than (121±39) min, (3.2±1.5) d and (3.2±1.5) d in laparotomy group (t=-2.175, -4.072, -3.397; P 0.05). Conclusions Advanced age is not a contraindication for laparoscopic operation. With the positive and reasonable perioperative management, LC+LCBDE is feasible, effective and safe for the elderly patients with choledocholithiasis and cholecystolithiasis. It can effectively shorten the operation time, accelerate the recovery, reduce postoperative pain and incidence of postoperative complications. Key words: Aged; Choledocholithiasis; Cholecystolithiasis; Laparoscopes