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Año 2019 / Volumen 111 / Número 3
Original

Two-stage versus single-stage procedure for the management of cholecystocholedocholithiasis in elderly patients: a retrospectively cohort study

176-181

DOI: 10.17235/reed.2018.5822/2018

Yong Zhou, Wen-Zhang Zha, Ren-Gen Fan, Guo-qin Jiang, Xu-dong Wu,

Resumen

Background: there is an increasing incidence rate of cholecysto-choledocholithiasis associated with the increasing proportion of senile individuals. Methods: a total of 100 elderly patients (over 80 years of age) suffering both from cholelithiasis and choledocholithiasis were retrospectively studied from January 2010 to December 2016. Patients were scheduled for either a single-stage or two-stage procedure. The LCBDE group (n = 54) included cases that underwent a single stage procedure of laparoscopic exploration of the common bile duct combined with cholecystectomy. The ERCP/EST group (n = 46) included cases that underwent a two stage procedure of preoperative endoscopic retrograde cholangiopancreaticography with endoscopic sphincterotomy followed by cholecystectomy. Comorbidity conditions, presenting symptoms, bile duct clearance, length of hospital stay and the frequency of procedural, postoperative and long-term complications were recorded. Results: the LCBDE group had a higher stones clearance rate than the ERCP/EST group (100.0% vs 89.1%, p < 0.05). Postoperative complications and hospitalization length were comparable in the two groups (p > 0.05). There were more procedural complications in the ERCP/EST group than in the LCBDE group (10.8% vs 0%, p < 0.05). Furthermore, a patient in the ERCP/EST group died due to duodenal perforation. More patients in the ERCP/EST group experienced long-term complications than those in the LCBDE group (23.9% vs 3.7%, p < 0.05) during a mean follow-up period of 28.4 months. Conclusions: the single-stage procedure is a safe and effective technique for elderly patients with cholecysto-choledocholithiasis. LCBDE provides a good stone clearance rate with few long term complications.

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Bibliografía

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1. Hacker KA, Schultz CC, Helling TS. Choledochotomy for calculous disease in the elderly. Am J Surg. 1990;160:610-613.

DOI: 10.1016/S0002-9610(05)80755-X

2. Siegel JH, Kasmin FE. Biliary tract diseases in the elderly: management and outcomes. Gut. 1997;41:433-435.

DOI: 10.1136/gut.41.4.433

3. Harness JK, Strodel WE, Talsma SE. Symptomatic biliary tract disease in the elderly patient. Am Surg. 1986;52:442-445.

4. Lukens FJ, Howell DA, Upender S, et al. ERCP in the very elderly: outcomes among patients older than eighty. Dig Dis Sci. 2010;55:847-851.

DOI: 10.1007/s10620-009-0784-6

5. Phillips EH, Toouli J, Pitt HA, et al. Treatment of common bile duct stones discovered during cholecystectomy, J. Gastrointest. Surg. 2008;12:624-628.

6. Gonzalez JJ, Sanz L, Grana JL, et al. Biliary lithiasis in the elderly patient: morbidity and mortality due to biliary surgery. Hepatogastroenterology 1997;44: 1565-1568.

DOI: 10.1007/s00268-014-2537-8

8. Andriulli A, Loperfido S, Napolitano G, et al. Incidence rates of post- ERCP complications: a systematic survey of prospective studies. Am J Gastroenterol 2007;102:1781-8.

DOI: 10.1111/j.1572-0241.2007.01279.x

9. Freeman ML, Nelson DB, Sherman S, et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med 1996;335:909-18.

DOI: 10.1056/NEJM199609263351301

10. Anderson MA, Fisher L, Jain R, et al. Complications of ERCP. Gastrointest Endosc 2012;75:467-73.

DOI: 10.1016/j.gie.2011.07.010

11. Mitchell RM, O’Connor F, Dickey W. Endoscopic retrograde cholangiopancreaticography is safe and effective in patients 90 years of age and older.J Clin Gastroenterol 2003;36:72-4.

DOI: 10.1097/00004836-200301000-00019

12. Rodriguez-Gonzalez FJ, Naranjo-Rodriguez A, Mata-Tapia I, et al. ERCP in patients 90 years of age and older. Gastrointest Endosc 2003;58:220-225.

DOI: 10.1067/mge.2003.363

13. Hui CK, Liu CL, Lai KC, et al. Outcome of emergency ERCP for acute cholangitis in patients 90 years of age and older. Alimentary Pharmacology and Therapeutics 2004;19(11):1153-1158.

DOI: 10.1111/j.1365-2036.2004.01962.x

14. Sgourakis G, Lanitis S, Karaliotas Ch, et al. Laparoscopic versus endoscopic primary management of choledocholithiasis. A Retrosp. Casecontrol study [in Ger. Chir. 2012;83: 897-903.

DOI: 10.1007/s00104-012-2279-9

DOI: 10.1007/s00464-010-0891-7

DOI: 10.1097/SLA.0000000000002731

17. Zhou Y, Zha WZ, Wu XD, et al. Three modalities on management of choledocholithiasis: a prospective cohort study. International Journal of Surgery 2017;44:269-273.

DOI: 10.1016/j.ijsu.2017.06.032

18. Zhou Y, Wu XD, Zha WZ, et al. Three modalities on common bile duct exploration. Z Gastroenterol. 2017;55(9):856-860.

DOI: 10.1055/s-0043-112655

19. Provinciali M, Smorlesi A. Immunoprevention and immunotherapy of cancer in ageing. Cancer Immunol Immunother 2005;54(2):93-106.

DOI: 10.1007/s00262-004-0539-3

DOI: 10.1016/S0140-6736(97)09175-7

DOI: 10.1016/S0016-5107(98)70298-6

22. Geron N, Reshef R, Shiller M, et al.The role of endoscopic retrograde cholangiopancreatography in the laparoscopic era. Surg Endosc 1999;13:452-456.

DOI: 10.1007/PL00022936

DOI: 10.1055/s-0030-1255934

24. Fritz E, Kirchgatterer A, Hubner D, et al. ERCP is safe and effective in patients 80 years of age and older compared with younger patients. Gastrointest Endosc 2006;64:899-905.

DOI: 10.1016/j.gie.2006.05.010

DOI: 10.1016/j.gie.2015.04.032

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DOI: 10.1016/j.gie.2006.01.022

27. Stromberg C, Nilsson M. Nationwide study of the treatment of common bile duct stones in Sweden between 1965 and 2009. Br J Surg 2011;98:1766–1774

DOI: 10.1002/bjs.7690

28. Overby DW, Apelgren KN, Richardson W. SAGES guidelines for the clinical application of laparoscopic biliary tract surgery. Surg Endosc 2010;24:2368–2386

DOI: 10.1007/s00464-010-1268-7

30. Zheng C, Huang Y, Xie E, et al. Laparoscopic common bile duct exploration: a safe and definitive treatment for elderly patients. Surgical Endoscopy 2017;31(6):2541-2547.

DOI: 10.1007/s00464-016-5257-3

31. Lyass S, Phillips EH. Laparoscopic transcystic duct common bile duct exploration. Surg Endosc 2006;20(Suppl 2) :S441–S445

DOI: 10.1007/s00464-006-0029-0

32. Petelin JB. Laparoscopic common bile duct exploration. Surg Endosc 2003;17:1705–1715

DOI: 10.1007/s00464-002-8917-4

33. Loperfido S, Angelini G, Benedetti G, et al. Major early complications from diagnostic and therapeutic ERCP:A prospective multicenter study. Gastrointest Endosc 1998;48:1–10.

DOI: 10.1016/S0016-5107(98)70121-X

34. Vandervoort J, Soetikno RM, Tham TC, et al. Risk factors for complications after performance of ERCP. Gastrointest Endosc 2002;56:652–656.

DOI: 10.1016/S0016-5107(02)70112-0

35. Williams EJ, Taylor S, Fairclough P, et al. Risk factors for complication following ERCP; results of a large-scale, prospective multicenter study. Endoscopy 2007;39:793–801.

DOI: 10.1055/s-2007-966723

36. Wang P, Li ZS, Liu F, et al.Risk factors for ERCP related complications: A prospective multicenter study. Am. J. Gastroenterol 2009;104:31–40.

37. Mattila A, Luhtala J, Mrena J, et al. An audit of shortand long-term outcomes after laparoscopic removal of common bile duct stones in Finland. Surg Endosc 2014;28(12) :3451-3457.

DOI: 10.1007/s00464-014-3620-9

39. Dasari BV, Tan CJ, Gurusamy KS, et al. Surgical versus endoscopic treatment of bile duct stones. Cochrane Database Systematic Reviews 2013; 3 (9):CD003327

DOI: 10.1007/s00464-001-9104-8

DOI: 10.4174/astr.2014.86.1.1

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Recibido: 10/07/2018

Aceptado: 10/10/2018

Prepublicado: 03/12/2018

Publicado: 04/03/2019

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