Abstract:

Objective

To evaluate the safety and efficacy of laparoscopic surgery for elderly patients with acute obstructive suppurative cholangitis （AOSC）.

Methods

Clinical data of 67 patients with AOSC who underwent laparoscopic surgery in Beijing Electric Power Hospital of State Grid Corporation of China from July 2019 to September 2023 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them，34 patients were male and 33 female，aged 39-93 years，with a median age of 72 years. According to the age，all patients were divided into the elderly （≥80 years，n=19） and non-elderly groups （＜ 80 years，n=48）. Perioperative parameters were observed in two groups. Operation time and the length of postoperative hospital stay between two groups were compared by t test. The incidence of postoperative complications was compared by Chi-square test.

Results

There were 6，12，15 and 8 cases of atherosclerotic coronary heart disease，hypertension，hepatic insufficiency and hypoproteinemia before surgery in the elderly group，and 4，15，22 and 9 cases in the non-elderly group，respectively. The incidence of preoperative complications in the elderly group was significantly higher than that in the non-elderly group （χ²=5.793，5.760，6.036，3.921； P＜0.05）.All patients successfully completed laparoscopic surgery，and no case was converted to open surgery.37 cases underwent laparoscopic common bile duct exploration （LCBDE），28 cases received laparoscopic transcystic common bile duct exploration （LTCBDE） and 2 cases underwent micro-incision of the cystic duct confluence in common bile duct exploration （LTM-CBDE）. No significant differences were found in the operation time，intraoperative blood loss and length of postoperative hospital stay between two groups（P＞0.05）. The average length of postoperative hospital stay of patients treated with LTCBDE was （9.3±1.9） d，significantly shorter than （17.1±5.4） d of those undergoing LCBDE （t=-7.286， P＜0.05）. The cure rate of all patients was 100%. During postoperative 1-48 month follow-up，all patients normally survived without bile duct injury or recurrence of common bile duct stones.

Conclusions

The incidence of preoperative complications in elderly patients with AOSC is high. Laparoscopic surgery is safe and feasible under strict preoperative preparations，accurate surgical timing and technique and intimate perioperative monitoring.LTCBDE has evident advantages over alternative procedures.

Key words: Elderly, Acute obstructive suppurative cholangitis, Laparoscopes, Surgical procedures，operative