Comparison of Laparoscopic Cholecystectomy Outcome with Laparoscopic Versus Endoscopic Bile Duct Exploration in Elderly Patients with Cholecystolithiasis and Choledocholithiasis.

Abstract

Objective: To evaluate the efficacy and safety of minimally invasive surgery in elderly patients with cholecystolithiasis and choledocholithiasis and its effects on liver function and stress response.

Study design: Comparative observational study. Place and Duration of the Study: Department of Hepatobiliary Surgery, Anyang City People's Hospital, Xinxiang Medical College, Anyang, China, from August 2021 to 2023.

Methodology: Eighty-six elderly patients with cholecystolithiasis and choledocholithiasis were divided into two distinct groups. The control group (n = 43) underwent endoscopic retrograde cholangiopancreatography (ERCP) in conjunction with laparoscopic cholecystectomy (LC). The observation group (n = 43) received LC along with laparoscopic common bile duct exploration (LCBDE). Comparative analysis of perioperative outcomes, complication rates, the frequency of residual stones, and liver function markers, including total bilirubin (TBil), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) was made. Furthermore, inflammatory markers such as tumour necrosis factor-alpha (TNF-α), C-reactive protein (CRP), and Interleukin-6 (IL-6), as well as stress markers including cortisol and epinephrine were also evaluated. Also, the quality of life both before and after surgery was assessed.

Results: The observation group had better perioperative outcomes with a lower complication rate (4.65% vs. 20.93% in controls, p <0.05). Both groups showed significant post-surgical improvements in liver function markers (TBil, AST, ALT, p <0.05), with no significant inter-group differences. Postoperative inflammatory (TNF-α, CRP, IL-6) and stress markers (cortisol, epinephrine) increased significantly (p <0.05), with trends favouring lower levels in the observation group. Quality of life scores significantly improved in both groups one month post-surgery (p <0.05).

Conclusion: LC combined with LCBDE is as effective as ERCP combined with LC for removing stones and improving liver function and quality of life in elderly patients with cholecystolithiasis and choledocholithiasis. However, the LC combined with the laparoscopic common bile duct exploration approach has fewer complications, reduces inflammation and stress responses, and supports better overall recovery, making it the preferred option for this patient population.

Key words: Gallstone, Choledocholithiasis, Old age, Minimally invasive surgery, Liver function, Stress response.