Primary duct closure after laparoscopic common bile duct exploration in elderly patients with cholecystocholedocholithiasis: a propensity-matched analysis

BACKGROUND: Laparoscopic common bile duct exploration (LCBDE) is a minimally invasive option for treating cholecystocholedocholithiasis. Primary duct closure (PDC) after laparoscopic common bile duct exploration has been shown to be safe. This study aims to evaluate the feasibility and safety of LCBDE + PDC in elderly (≥ 65 years) patients. METHODS: This study included 284 elderly patients who underwent LCBDE(PDC group = 86, T-tube drainage group = 198). We compared the baseline characteristics and perioperative data between the two groups. The Propensity Score Matching (PSM) method was employed to balance the baseline characteristics of the groups and mitigate potential biases. RESULTS: The PDC group showed shorter operative time (105 vs. 130 min, P < 0.001), reduced postoperative hospital stays (7 days vs. 8 days, P < 0.001) and total hospital stays (11.5 days vs. 13 days, P < 0.001), and lower costs (3273.6 USD vs. 3848.4 USD, P < 0.001) compared to the T-tube group. The rates of postoperative bile leakage (4.65% vs. 2.02%, P = 0.25) and severe complications (3.49% vs. 3.54%, P = 1) were comparable between the two groups. After PSM, PDC group maintained advantages in operative time (105 min vs. 130 min, P < 0.001) and costs ( 3310.9 USD vs. 3719.4 USD, P = 0.012). CONCLUSIONS: Our study demonstrates that LCBDE + PDC is a safe and feasible treatment for elderly patients with cholecystocholedocholithiasis.