Laparoscopic Common Bile Duct Exploration for Choledocholithiasis in the Elderly: A Systematic Review and Meta-Analysis.

Abstract

Introduction: Laparoscopic common bile duct exploration (LCBDE) is a well-established and effective minimally invasive surgical approach for managing choledocholithiasis. However, its safety in the elderly population is not well established. Therefore, this study compares surgery-related outcomes in elderly patients undergoing LCBDE. Methods: We systematically searched PubMed, Embase, and Cochrane Library for studies comparing elderly and young patients undergoing LCBDE. Binary outcomes were compared using odds ratios (ORs), with 95% confidence intervals (CIs). Heterogeneity was assessed with I² statistics. Statistical analysis was performed using Software R, version 4.3.3. Results: Twelve studies comprising 3791 patients were included, of whom 1411 patients (37%) were from the elderly group. Elderly patients were associated with an increase in mortality (OR: 3.42; 95% CI: 1.08-10.85; P = .04; I² = 0%), overall postoperative complications (OR: 1.60; 95% CI: 1.11-2.22; P = .01; I² = 52%), and pneumonia (OR: 4.37; 95% CI: 2.00-9.55; P < .01; I² = 0%) rates. However, there were no significant differences between groups in remnant stones (OR: 1.37; 95% CI: 0.70-2.68; P = .36; I² = 0%) and recurrent stones (OR: 1.37; 95% CI: 0.64-2.95; P = .42; I² = 0%) pancreatitis (OR: 0.98; 95% CI: 0.16-5.95; P = .98; I² = 0%) and bile leakage (OR: 1.24; 95% CI: 0.75-2.07; P = .40; I² = 0%). Conclusion: In this meta-analysis, elderly patients who underwent LCBDE experienced increased mortality, overall complications, and pneumonia rates compared with young patients. Furthermore, there were no significant differences between the groups in remnant and retained stones, pancreatitis, and bile leakage.