Safety and Efficacy of Self-Expelling Biliary Stents for Choledocholithiasis in Elderly Patients: A Single-Center Retrospective Study.

BACKGROUND

This study aimed to evaluate the safety and clinical efficacy of self-expelling biliary stents in elderly patients undergoing laparoscopic and cholangioscopic procedures for gallbladder and common bile duct (CBD) stones.

METHODS

Clinical data from 220 geriatric patients treated at Yixing People's Hospital from January 2019 to April 2025 for primary CBD stones were retrospectively analyzed. All patients underwent laparoscopic common bile duct exploration (LCBDE) with intraoperative placement of a 6F self-expelling J-stent under cholangioscopic guidance, followed by primary duct closure using 4-0 polyglycolic acid sutures. Both the safety and effectiveness of the treatment were observed. Outcomes included operative metrics, bile leakage rates (International Study Group for Liver Surgery criteria), and stent expulsion time.

RESULTS

All procedures were completed laparoscopically without conversion. Mean operative time was 95.3 ± 15.2 minutes, with blood loss of 35.0 ± 8.66 mL. Stents were spontaneously expelled within 4.4 ± 1.3 days. Postoperative liver function (alanine transaminase/aspartate transaminase) and inflammatory markers (interleukin-6) improved significantly (all P < .001). Complications included wound infection (2.2%, n = 5) and bile leakage (0.4%, n = 1). Hospital stay was shorter (5.2 ± 0.6) days compared with historical T-tube drainage (TTD) cohorts.

CONCLUSION

For elderly patients, self-expelling biliary stents have shown promising therapeutic results when used during LCBDE. Elderly patients benefit from the stents' adequate biliary drainage and decompression, which promotes an early recovery following surgery. Its "no-tube" strategy may reduce TTD-related burdens. In the future, multicenter prospective randomized controlled trials will be needed to confirm its superiority.