Clinical effect of laparoscopic biliary reoperation in treatment of elderly patients with extrahepatic bile duct stones

Objective To investigate the clinical effect of laparoscopic biliary reoperation in the treatment of elderly patients with extrahepatic bile duct stones.Methods A retrospective analysis was performed for the clinical data of 86 elderly patients with extrahepatic bile duct stones who were admitted to The First People's Hospital of Zaoyang from January 2013 to June 2015 and underwent laparoscopic biliary reoperation.The surgical conditions and follow- up results were compared between groups.The t- test was used for comparison of continuous data between groups,the chi- square test was used for comparison of categorical data between groups.Results All the patients underwent the surgery successfully and no patient died during the perioperative period.The postoperative stone clearance rate was 100%.There was no significant difference in the surgical procedure( primary suture / T- tube drainage) between the two groups( P > 0.05).Compared with the first operation group,the reoperation group had a higher rate of conversion to laparotomy,a longer length of hospital stay,higher intraoperative stone clearance rate and incidence rates of intraoperative and postoperative complications,and a significantly longer time of operation( t = 2.126,P = 0.036).In the first operation group,one patient experienced intraoperative cystic artery injury and was given ligation for hemostasis;in the reoperation group,2 patients experienced gastrointestinal serosal injury and were treated with embedding of the seromuscular layer.In the first operation group,1 patient each experienced bile leakage,pulmonary infection,and urinary system infection after surgery and were all cured after conservative treatment;in the reoperation group,1 patient experienced bile leakage and 2 experienced pulmonary infection,and all the patients were cured after conservative treatment.The overall follow- up rate was 94.19%( 50 /54) in the first operation group and 96.88%( 31 /32) in the reoperation group.The imaging examination showed no complications such as biliary stricture,residual bile duct stones,and recurrence of stones.Conclusion Laparoscopic biliary reoperation is safe and effective in the treatment of elderly patients with extrahepatic bile duct stones,but there are a certain rate of conversion to laparotomy and incidence rates of complications.The operation techniques should be improved to avoid intraoperative injury,surgical indications should be strictly followed,and perioperative management should be optimized.