Risk factors for bile leakage after laparoscopic common bile duct exploration in older patients with choledocholithiasis

Abstract

BACKGROUND

At present, there are few studies on the risk factors for bile leakage after laparoscopic common bile duct exploration (LCBDE) for older patients with choledocholithiasis.

AIM

To identify the potential risk factors for bile leakage after LCBDE in older patients.

METHODS

A retrospective, single-center observational analysis was performed on patients aged ≥ 70 years with choledocholithiasis treated by LCBDE who were admitted to our center between January 2011 and August 2022. The included patients were divided into non-bile leakage and bile leakage groups. Risk factors were determined by analyzing the observation indicators.

RESULTS

Seventy older patients with choledocholithiasis who underwent LCBDE were included. Univariate analysis showed that positive culture of bile bacteria was a risk factor for bile leakage after LCBDE (P < 0.05). We further analyzed the bile bacteria, and univariate analysis showed that Enterococcus faecalis (E. faecalis) (P < 0.05) and Pseudomonas aeruginosa (P < 0.05) were associated with an increased risk of postoperative bile leakage in older patients (P < 0.05). Multivariate analysis showed that E. faecalis was an independent risk factor for postoperative bile leakage in older patients (P < 0.05). The results of antibiotic sensitivity analysis showed that E. faecalis had 100% susceptibility to penicillin, ampicillin, linezolid, vancomycin, and furantoin.

CONCLUSION

E. faecalis-associated biliary tract infection is an independent risk factor for bile leakage after LCBDE in older patients with choledocholithiasis. We suggest coverage with antibiotics to which E. faecalis is sensitive.

Keywords: Bile leakage; Common bile duct stones; Older patients; Laparoscopic common bile duct exploration; Enterococcus faecalis; Antibiotic sensitivity

Core Tip: This is a retrospective single-center observational study to investigate the potential risk factors for bile leakage after laparoscopic common bile duct exploration in elderly patients. Enterococcus faecalis (E. faecalis) is an independent risk factor for postoperative bile leakage in elderly patients. The results of drug sensitivity analysis showed that E. faecalis was fully sensitive to penicillin, ampicillin, linezolid, vancomycin, and furantoin. In elderly patients with choledocholithiasis who are at risk of postoperative bile leakage, we suggest covering sensitive drugs for E. faecalis in the empiric regimen of antibiotics.