Year 2019 / Volume 111 / Number 3
Original
Two-stage versus single-stage procedure for the management of cholecystocholedocholithiasis in elderly patients: a retrospectively cohort study

176-181

DOI: 10.17235/reed.2018.5822/2018

Yong Zhou, Wen-Zhang Zha, Ren-Gen Fan, Guo-qin Jiang, Xu-dong Wu,

Abstract
Background: there is an increasing incidence rate of cholecysto-choledocholithiasis associated with the increasing proportion of senile individuals. Methods: a total of 100 elderly patients (over 80 years of age) suffering both from cholelithiasis and choledocholithiasis were retrospectively studied from January 2010 to December 2016. Patients were scheduled for either a single-stage or two-stage procedure. The LCBDE group (n = 54) included cases that underwent a single stage procedure of laparoscopic exploration of the common bile duct combined with cholecystectomy. The ERCP/EST group (n = 46) included cases that underwent a two stage procedure of preoperative endoscopic retrograde cholangiopancreaticography with endoscopic sphincterotomy followed by cholecystectomy. Comorbidity conditions, presenting symptoms, bile duct clearance, length of hospital stay and the frequency of procedural, postoperative and long-term complications were recorded. Results: the LCBDE group had a higher stones clearance rate than the ERCP/EST group (100.0% vs 89.1%, p < 0.05). Postoperative complications and hospitalization length were comparable in the two groups (p > 0.05). There were more procedural complications in the ERCP/EST group than in the LCBDE group (10.8% vs 0%, p < 0.05). Furthermore, a patient in the ERCP/EST group died due to duodenal perforation. More patients in the ERCP/EST group experienced long-term complications than those in the LCBDE group (23.9% vs 3.7%, p < 0.05) during a mean follow-up period of 28.4 months. Conclusions: the single-stage procedure is a safe and effective technique for elderly patients with cholecysto-choledocholithiasis. LCBDE provides a good stone clearance rate with few long term complications.
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References
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DOI: 10.1016/S0002-9610(05)80755-X
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24. Fritz E, Kirchgatterer A, Hubner D, et al. ERCP is safe and effective in patients 80 years of age and older compared with younger patients. Gastrointest Endosc 2006;64:899-905.
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25. Finkelmeier F, Tal A, Ajouaou M, et al. ERCP in elderly patients: increased risk of sedation adverse events but low frequency of post-ercp pancreatitis. Gastrointestinal Endoscopy 2015;82(6):1051-1059.
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DOI: 10.1007/s00464-016-5257-3
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34. Vandervoort J, Soetikno RM, Tham TC, et al. Risk factors for complications after performance of ERCP. Gastrointest Endosc 2002;56:652–656.
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39. Dasari BV, Tan CJ, Gurusamy KS, et al. Surgical versus endoscopic treatment of bile duct stones. Cochrane Database Systematic Reviews 2013; 3 (9):CD003327
40. Schreurs WH, Juttmann JR, Stuifbergen WN, et al. Management of common bile duct stones: selective endoscopic retrograde cholangiography and endoscopic sphincterotomy: short- and long-term results. Surg Endosc 2002;16:1068-1072.
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DOI: 10.4174/astr.2014.86.1.1
1. Hacker KA, Schultz CC, Helling TS. Choledochotomy for calculous disease in the elderly. Am J Surg. 1990;160:610-613.
DOI: 10.1016/S0002-9610(05)80755-X
2. Siegel JH, Kasmin FE. Biliary tract diseases in the elderly: management and outcomes. Gut. 1997;41:433-435.
DOI: 10.1136/gut.41.4.433
3. Harness JK, Strodel WE, Talsma SE. Symptomatic biliary tract disease in the elderly patient. Am Surg. 1986;52:442-445.
4. Lukens FJ, Howell DA, Upender S, et al. ERCP in the very elderly: outcomes among patients older than eighty. Dig Dis Sci. 2010;55:847-851.
DOI: 10.1007/s10620-009-0784-6
5. Phillips EH, Toouli J, Pitt HA, et al. Treatment of common bile duct stones discovered during cholecystectomy, J. Gastrointest. Surg. 2008;12:624-628.
6. Gonzalez JJ, Sanz L, Grana JL, et al. Biliary lithiasis in the elderly patient: morbidity and mortality due to biliary surgery. Hepatogastroenterology 1997;44: 1565-1568.
7. Reinders JS, Gouma DJ, Ubbink DT, et al. Transcystic or transductal stone extraction during single-stage treatment of choledochocystolithiasis: asystematic review. World J Surg 2014;38 (9): 2403-2411.
DOI: 10.1007/s00268-014-2537-8
8. Andriulli A, Loperfido S, Napolitano G, et al. Incidence rates of post- ERCP complications: a systematic survey of prospective studies. Am J Gastroenterol 2007;102:1781-8.
DOI: 10.1111/j.1572-0241.2007.01279.x
9. Freeman ML, Nelson DB, Sherman S, et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med 1996;335:909-18.
DOI: 10.1056/NEJM199609263351301
10. Anderson MA, Fisher L, Jain R, et al. Complications of ERCP. Gastrointest Endosc 2012;75:467-73.
DOI: 10.1016/j.gie.2011.07.010
11. Mitchell RM, O’Connor F, Dickey W. Endoscopic retrograde cholangiopancreaticography is safe and effective in patients 90 years of age and older.J Clin Gastroenterol 2003;36:72-4.
DOI: 10.1097/00004836-200301000-00019
12. Rodriguez-Gonzalez FJ, Naranjo-Rodriguez A, Mata-Tapia I, et al. ERCP in patients 90 years of age and older. Gastrointest Endosc 2003;58:220-225.
DOI: 10.1067/mge.2003.363
13. Hui CK, Liu CL, Lai KC, et al. Outcome of emergency ERCP for acute cholangitis in patients 90 years of age and older. Alimentary Pharmacology and Therapeutics 2004;19(11):1153-1158.
DOI: 10.1111/j.1365-2036.2004.01962.x
14. Sgourakis G, Lanitis S, Karaliotas Ch, et al. Laparoscopic versus endoscopic primary management of choledocholithiasis. A Retrosp. Casecontrol study [in Ger. Chir. 2012;83: 897-903.
DOI: 10.1007/s00104-012-2279-9
15. Bansal VK, Misra MC, Garg P, et al. A prospective randomized trial comparing two-stage versus single-stage management of patients with gallstone disease and common bile duct stones. Surg Endosc. 2010;24:1986-1989
DOI: 10.1007/s00464-010-0891-7
16. Pan L, Chen M, Ji L, et al. The safety and efficacy of laparoscopic common bile duct exploration combined with cholecystectomy for the management of cholecysto-choledocholithiasis: an up-to-date meta-analysis. Annals of Surgery 2018;30(4):39.
DOI: 10.1097/SLA.0000000000002731
17. Zhou Y, Zha WZ, Wu XD, et al. Three modalities on management of choledocholithiasis: a prospective cohort study. International Journal of Surgery 2017;44:269-273.
DOI: 10.1016/j.ijsu.2017.06.032
18. Zhou Y, Wu XD, Zha WZ, et al. Three modalities on common bile duct exploration. Z Gastroenterol. 2017;55(9):856-860.
DOI: 10.1055/s-0043-112655
19. Provinciali M, Smorlesi A. Immunoprevention and immunotherapy of cancer in ageing. Cancer Immunol Immunother 2005;54(2):93-106.
DOI: 10.1007/s00262-004-0539-3
20. Rhodes M, Sussman L, Cohen L, et al. Randomised trial of laparoscopic exploration of common bile duct versus postoperative endoscopic retrograde cholangiography for common bile duct stones. Lancet 1998;351:159-161.
DOI: 10.1016/S0140-6736(97)09175-7
21. Tham TC, Lichtenstein DR, Vandervoort J, et al. Role of endoscopic retrograde cholangiopancreatography for suspected choledocholithiasis in patients undergoing laparoscopic cholecystectomy. Gastrointest Endosc 1998;47:50-56.
DOI: 10.1016/S0016-5107(98)70298-6
22. Geron N, Reshef R, Shiller M, et al.The role of endoscopic retrograde cholangiopancreatography in the laparoscopic era. Surg Endosc 1999;13:452-456.
DOI: 10.1007/PL00022936
23. Katsinelos P, Kountouras J, Chatzimavroudis G, et al. Outpatient therapeutic endoscopic retrograde cholangiopancreaticography is safe in patients aged 80 years and older. Endoscopy 2011;43:128-133.
DOI: 10.1055/s-0030-1255934
24. Fritz E, Kirchgatterer A, Hubner D, et al. ERCP is safe and effective in patients 80 years of age and older compared with younger patients. Gastrointest Endosc 2006;64:899-905.
DOI: 10.1016/j.gie.2006.05.010
25. Finkelmeier F, Tal A, Ajouaou M, et al. ERCP in elderly patients: increased risk of sedation adverse events but low frequency of post-ercp pancreatitis. Gastrointestinal Endoscopy 2015;82(6):1051-1059.
DOI: 10.1016/j.gie.2015.04.032
26. Keizman D, Ish Shalom M, Konikoff FM. Recurrent symptomatic common bile duct stones after endoscopic stone extraction in elderly patients. Gastrointest Endosc 2006;64:60–65
DOI: 10.1016/j.gie.2006.01.022
27. Stromberg C, Nilsson M. Nationwide study of the treatment of common bile duct stones in Sweden between 1965 and 2009. Br J Surg 2011;98:1766–1774
DOI: 10.1002/bjs.7690
28. Overby DW, Apelgren KN, Richardson W. SAGES guidelines for the clinical application of laparoscopic biliary tract surgery. Surg Endosc 2010;24:2368–2386
DOI: 10.1007/s00464-010-1268-7
29. Kenny R, Richardson J, McGlone ER, et al. Laparoscopic common bile duct exploration versus pre or post-operative ERCP for common bile duct stones in patientsundergoing cholecystectomy: Is there any difference? , Int J Surg 2014;12:989–993
30. Zheng C, Huang Y, Xie E, et al. Laparoscopic common bile duct exploration: a safe and definitive treatment for elderly patients. Surgical Endoscopy 2017;31(6):2541-2547.
DOI: 10.1007/s00464-016-5257-3
31. Lyass S, Phillips EH. Laparoscopic transcystic duct common bile duct exploration. Surg Endosc 2006;20(Suppl 2) :S441–S445
DOI: 10.1007/s00464-006-0029-0
32. Petelin JB. Laparoscopic common bile duct exploration. Surg Endosc 2003;17:1705–1715
DOI: 10.1007/s00464-002-8917-4
33. Loperfido S, Angelini G, Benedetti G, et al. Major early complications from diagnostic and therapeutic ERCP:A prospective multicenter study. Gastrointest Endosc 1998;48:1–10.
DOI: 10.1016/S0016-5107(98)70121-X
34. Vandervoort J, Soetikno RM, Tham TC, et al. Risk factors for complications after performance of ERCP. Gastrointest Endosc 2002;56:652–656.
DOI: 10.1016/S0016-5107(02)70112-0
35. Williams EJ, Taylor S, Fairclough P, et al. Risk factors for complication following ERCP; results of a large-scale, prospective multicenter study. Endoscopy 2007;39:793–801.
DOI: 10.1055/s-2007-966723
36. Wang P, Li ZS, Liu F, et al.Risk factors for ERCP related complications: A prospective multicenter study. Am. J. Gastroenterol 2009;104:31–40.
37. Mattila A, Luhtala J, Mrena J, et al. An audit of shortand long-term outcomes after laparoscopic removal of common bile duct stones in Finland. Surg Endosc 2014;28(12) :3451-3457.
DOI: 10.1007/s00464-014-3620-9
38. Naumowicz E, Białecki J, Kołomecki K. Results of treatment of patients with gallstone disease and ductal calculi by single-stage laparoscopic cholecystectomy and bile duct exploration. Wideochir Inne Tech. Maloinwazyjne 2014;9 (2): 179-189.
39. Dasari BV, Tan CJ, Gurusamy KS, et al. Surgical versus endoscopic treatment of bile duct stones. Cochrane Database Systematic Reviews 2013; 3 (9):CD003327
40. Schreurs WH, Juttmann JR, Stuifbergen WN, et al. Management of common bile duct stones: selective endoscopic retrograde cholangiography and endoscopic sphincterotomy: short- and long-term results. Surg Endosc 2002;16:1068-1072.
DOI: 10.1007/s00464-001-9104-8
41. Lee HM, Min SK, Lee HK. Long-term results of laparoscopic common bile duct exploration by choledochotomy for choledocholithiasis: 15-year experience from a single center. Annals of Surgical Treatment & Research 2014;86(1):1.
DOI: 10.4174/astr.2014.86.1.1
42. García-Cano J, González Martín JA, Morillas Ariño MJ, et al. Outcomes of bile duct drainage by means of ERCP in geriatric patients. Rev Esp Enferm Dig 2007;99:451-6. [Article in Spanish and English].
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Zhou Y, Zha W, Fan R, Jiang G, Wu X. Two-stage versus single-stage procedure for the management of cholecystocholedocholithiasis in elderly patients: a retrospectively cohort study. 5822/2018


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Received: 10/07/2018

Accepted: 10/10/2018

Online First: 03/12/2018

Published: 04/03/2019

Article revision time: 85 days

Article Online First time: 146 days

Article editing time: 237 days


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Articles
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Previous issues
Most read articles
Clinical guidelines
Reviews
Topic collection
Submit a manuscript
Submit a manuscript
Information for authors
Language editing services
Editorial time – Publication time
REED awards
ORCID guide
PubMed guide
Journal info
About the journal
Editorial board
For reviewers
For advertisers
REED centenary
Open access
Articles in press
Home
Articles
Current issues
Previous issues
Most read articles
Clinical guidelines
Reviews
Topic collection
Submit a manuscript
Submit a manuscript
Information for authors
Language editing services
Editorial time – Publication time
REED awards
ORCID guide
PubMed guide
Journal info
About the journal
Editorial board
For reviewers
For advertisers
REED centenary
Open access
Articles in press
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