OUTCOME OF SURGERY FOR FAILED ENDOSCOPIC EXTRACTION OF COMMON BILE-DUCT STONES IN ELDERLY PATIENTS

Endoscopic sphincterotomy (ES) is the treatment of choice for common b ile duct stones in elderly patients. For those in whom endoscopic clea rance of the common bile duct fails the treatment options include sten ting, dissolution therapy and lithotripsy. Surgery is often avoided be cause of the reported high morbidity and mortality in elderly patients . We have reviewed the outcome of patients referred for surgery after failed endoscopic clearance of common bile duct stones. Over a 3-year period, 100 patients with common bile duct stones were referred specif ically for endoscopic clearance of the common bile duct (median age 69 years, range 19-97 years). In seven patients duct clearance was possi ble without ES and in five patients ES was considered inappropriate. E S was attempted in 88 patients and was successful in 75 (85%). Of the 13 patients failing ES or stone removal, surgery was performed in nine and four were stented. Of patients having successful ES (n=75), ten w ere referred for surgery because of incomplete duct clearance. Surgery was performed to obtain duct clearance in 19 patients (eight male, 11 female, median age 77 years, range 47-90 years). Of the 19, eight had previously undergone a cholecystectomy (42%) and 17 of the 19 had bil iary tract drainage preoperatively (90%). The procedures performed con sisted of choledocholithotomy in all plus cholecystectomy (11), choled ochoduodenostomy (7) and choledochojejunostomy (7). There were no deat hs and only one major complication. The median total inpatient stay wa s 26 days (range 14-75 days) and the median postoperative stay was 12 days (range 7-50 days). We would conclude that open surgery can be per formed safely and effectively in elderly patients with retained bile d uct stones.