Safety and Outcomes of Laparoscopic Common Bile Duct Exploration in Elderly Patients: A Retrospective Comparative Cohort Study From a High-Volume Specialist Centre.

BACKGROUND

Laparoscopic common bile duct exploration (LCBDE) treats choledocholithiasis whilst avoiding morbidity associated with endoscopic retrograde cholangiopancreatography (ERCP). This study compared outcomes of LCBDE in patients aged < 70 years and ≥ 70 years at a high-volume specialist center.

METHODS

A retrospective analysis of a prospectively maintained database was performed for patients undergoing LCBDE between January 2011 and September 2024. Patients were stratified by age (< 70 vs. ≥ 70 years). Primary outcome was complete bile duct clearance. Secondary outcomes included operative time, length of stay (LOS), 30-day morbidity (Clavien-Dindo), conversion to open surgery, readmission, and retained stones. Statistical analyses used Mann-Whitney U and χ2 or Fisher's exact tests.

RESULTS

Four hundred and ninety-four patients underwent LCBDE (375 < 70 years; 119 ≥ 70 years). Elderly patients had higher ASA grades and Charlson Comorbidity Index scores (p < 0.001). Complete ductal clearance was achieved in 99.5% of younger and 100% of elderly patients (p = 0.20). Conversion to open surgery occurred in six patients. No perioperative mortality was observed. Median LOS was longer in elderly patients (3 vs. 2 days; p < 0.001). Thirty-day morbidity did not differ significantly between groups.

CONCLUSION

LCBDE is a safe and effective treatment for choledocholithiasis in selected elderly patients when performed in specialist centers.