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Laparoscopic common bile duct exploration for elderly patients with choledocholithiasis: a systematic review and meta-analysis

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Abstract

Background

Laparoscopic common bile duct exploration (LCBDE) has been becoming more and more popular in patients with symptomatic choledocholithiasis. However, the safety and effectiveness of LCBDE in elderly patients with choledocholithiasis is still uncertain. This meta-analysis is aimed to appraise the safety and feasibility of LCBDE for elderly patients with choledocholithiasis.

Materials and methods

Studies comparing elderly patients and younger patients who underwent LCBDE for common bile duct stone were reviewed and collected from the PubMed, Medline, EMBASE, and Cochrane Library. Primary outcomes were stone clearance rate, overall complication rate, and mortality rate. Secondary outcomes were operative time, conversion rate, pulmonary complication, bile leakage, reoperation, residual stone rate, and recurrent stone rate.

Results

Nine studies, including two prospective studies and seven retrospective studies, met the inclusion criteria. There were 2004 patients in this meta-analysis, including 693 elderly patients and 1311 younger patients. There was no statistically significant difference between elderly patients and younger patients regarding stone clearance rate (OR 0.73; 95% CI 0.42–1.26; p = 0.25), overall complication rate (OR 1.31; 95% CI 0.94–1.82; p = 0.12), and mortality rate (OR 2.80; 95% CI 0.82–9.53; p = 0.10). Similarly, the operative time, conversion rate, bile leakage, reoperation, residual stone rate, and recurrent stone rate showed no significant difference between two groups (p > 0.05). While elderly patients showed high risk for pulmonary complication (OR 4.41; 95% CI 1.78–10.93; p = 0.001) compared with younger patients.

Conclusion

Although there is associated with higher pulmonary complication, LCBDE is still considered as a safe and effective treatment for elderly patients with choledocholithiasis.

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Acknowledgements

This research was supported by the National Natural Science Foundation of China (Grant No. 81660401, 81860418).

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Author notes

  1. Jisheng Zhu and Shuju Tu contributed equally to this work, and both should be considered as first author.

Authors and Affiliations

  1. Department of General Surgery, The First Affiliated Hospital of Nanchang University, No.17 Yongwai Zhengjie, Nanchang, 330006, Jiangxi Province, China

    Jisheng Zhu, Shuju Tu, Zhengjiang Yang, Xiaowei Fu, Yong Li & Weidong Xiao

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  1. Jisheng Zhu
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Correspondence to Weidong Xiao.

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Drs. Jisheng Zhu, Shuju Tu, Zhengjiang Yang, Xiaowei Fu, Yong Li, and Weidong Xiao have no conflicts of interest or financial ties to disclose.

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Zhu, J., Tu, S., Yang, Z. et al. Laparoscopic common bile duct exploration for elderly patients with choledocholithiasis: a systematic review and meta-analysis. Surg Endosc 34, 1522–1533 (2020). https://doi.org/10.1007/s00464-020-07394-x

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