Laparoscopic Common Bile Duct Exploration With Primary Duct Closure for Management of Elderly Patients With Cholecystocholedocholithiasis: A Retrospective Cohort Study

BACKGROUND: Although laparoscopic common bile duct exploration with primary duct suture (LCBDE + PDC) is recognized as a feasible and safe approach for treating cholecystocholedocholithiasis, there is a paucity of studies examining its applicability in elderly patients. This study aims to investigate the safety and feasibility of primary suture in patients aged ≥ 65 years and older following LCBDE. METHODS: A total of 219 patients diagnosed with cholecystocholedocholithiasis who underwent LCBDE + PDC treatment were categorized into two groups: Group A (age ≥ 65 years, n = 86) and Group B (age < 65 years, n = 133). This study aims to compare the demographic characteristics and clinical outcomes between the two groups. RESULTS: This study reported no mortality cases. Compared to Group B, Group A had a longer duration of abdominal drainage placement (p = 0.008), longer postoperative hospital stay (p = 0.008), and longer total hospital stay (p < 0.001). In addition, the total costs in the elderly group were significantly higher (p < 0.001). The incidence of postoperative pneumonia in Group A was significantly higher than in Group B (5.81% vs. 0.75%, p = 0.036). There were no significant differences between the two groups in terms of operation time, estimated blood loss, holmium laser lithotripsy usage rate, and incidence of severe complications. CONCLUSIONS: For elderly patients who meet the surgical indications, laparoscopic common bile duct exploration with primary duct closure is considered safe and feasible. Nevertheless, surgeons should remain vigilant regarding the potential occurrence of postoperative pneumonia in the elderly population.