Safety and efficacy of emergency laparoscopic common bile duct exploration in elderly patients with complicated acute cholangitis

Abstract

Background Acute cholangitis (AC) is an acute inflammation of the biliary tract caused by bacterial infection, which occurs due to biliary obstruction primarily because of bile duct stones. We aimed to study the effect of laparoscopic common bile duct exploration in the treatment of complicated AC for elderly patients. Method Elderly patients with complicated AC admitted to our hospital from August 2014 to August 2018 were considered. According to the patients' general conditions and the American Society of Anesthesiologists' (ASA) grade, 98 patients were divided into three groups: ASA grade II, 38 patients; ASA grade III, 33 patients; and ASA grade IV, 27 patients; all patients underwent emergency laparoscopic common bile duct exploration within 8 h of admission. The perioperative data of these patients were analyzed. Results There were no significant differences between the three groups in preoperative laboratory test results, except for albumin levels. Conversely, when compared in every group, there were some significant differences in changes between pre-and postoperative laboratory test results, except for albumin levels. There were no significant differences between the groups in terms of perioperative data (operation time, blood loss, peritoneal drainage time, postoperative time to flatus, and postoperative hospital stay). Although four patients had postoperative complications, there were no significant differences in the rate of complications between the groups. Conclusion Laparoscopic common bile duct exploration is a safe, effective, and feasible method for treating complicated AC in elderly patients. It should be actively used in clinical work to rapidly relieve biliary obstruction.

Laparoscopic Approach in the Case of Biliary Obstruction: Choledocholithiasis

“…In addition, there is statistically less overall morbidity and a shorter duration of hospital stay after LCBDE when compared to OCBDE. The conclusion of this review disclosed more successful clinical results of LCBDE in CBD clearance when compared with OCBDE and ERCP [50].…”

“…Including 36 relevant papers, 3 meta-analyses, 8 randomized controlled trials, 18 retrospective, 4 prospective studies, and 3 review articles, the authors concluded that LCBDE compared to OCBDE, had significantly lower mortality (0.25% vs. 5.5%), less surgical site infection (1.2% vs. 10%), and overall morbidity (3.7% vs. 22%). The vast majority of the reviewed studies reported that LCBDE (through transductal and transcystic approach) was associated with CBD clearance rates greater than 84% [50].…”

“…This can be explained by the lower incidence of associated bile leak (1.4% vs. 6.9%), and shorter duration of hospital stay (4.9 vs. 7.3 days). In addition, one meta-analysis revealed that the mean duration of the operative time was statistically in favor of the transcystic approach (113.8 vs. 126.3 minutes) [50].…”

Laparoscopic trans-cystic common bile duct exploration and treatment of choledocholithiasis in a patient with Roux-en-Y reconstruction after gastrectomy: report of an emergency case

“…CBD detected stones, however, were removed with a trans-cystic Dormia basket and not under direct choledochoscopy view. Another paper [ 7 ] assessed emergency CBD exploration as safe and effective in elderly patients with complicated acute cholangitis.…”

Surgical Abdomen

“…Endoscopic Retrograde Cholangiopancreatography (ERCP) and sphincterotomy with removal of common bile duct stones followed by laparoscopic cholecystectomy is the preferred treatment option (Nassar and Richter 2019). Depending on the expertise of the surgeon laparoscopic common bile duct exploration during cholecystectomy is another option, even in the elderly (Jia et al 2020). In a meta-analysis, the single stage laparoscopic common bile duct exploration and cholecystectomy appears to be superior to the two stage endoscopic stone extraction followed by laparoscopic cholecystectomy in terms of technical failure, and shorter length of stay with no significant difference in mortality, morbidity, cost, or recurrent/retained stones (Singh and Kilambi 2018).…”