Xiong RF, Lu SS, Wu ZM, Huang HJ, Xiao T. Risk factors for bile leakage after laparoscopic common bile duct exploration in older patients with choledocholithiasis. World J Gastrointest Surg 2025; 17(4): 102697 [DOI: 10.4240/wjgs.v17.i4.102697]
Corresponding Author of This Article
Tao Xiao, MD, Department of General Surgery, First Affiliated Hospital of Nanchang University, No. 17 Yong Wai Zheng Street, Nanchang 330006, Jiangxi Province, China. xiaotao@ncu.edu.cn
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Apr 27, 2025; 17(4): 102697 Published online Apr 27, 2025. doi: 10.4240/wjgs.v17.i4.102697
Risk factors for bile leakage after laparoscopic common bile duct exploration in older patients with choledocholithiasis
Ruo-Fei Xiong, Shan-Shan Lu, Zhi-Ming Wu, Hong-Jun Huang, Tao Xiao
Ruo-Fei Xiong, Zhi-Ming Wu, Hong-Jun Huang, Department of General Surgery, Shaoxing Central Hospital, Shaoxing 312000, Zhejiang Province, China
Shan-Shan Lu, Department of Geriatrics, Shaoxing University Affiliated Hospital, Shaoxing 312000, Zhejiang Province, China
Tao Xiao, Department of General Surgery, First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
Co-first authors: Ruo-Fei Xiong and Shan-Shan Lu.
Author contributions: Xiong RF, Lu SS, and Wu ZM were responsible for the conception and design of the study and drafting the article; Xiong RF and Lu SS contributed equally to this article as co-first authors; Xiong RF, Lu SS, Wu ZM, and Huang HJ contributed to the data analysis and interpretation; Huang HJ contributed to acquisition of the data; Xiao T was responsible for revising the manuscript critically for important intellectual content, and final approval of the version to be submitted; and all authors thoroughly reviewed and endorsed the final manuscript.
Supported by the Ke Qiao Science and Technology Plan Projects, No. 2022KZ70.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Shaoxing Central Hospital, approval No. 2023029.
Informed consent statement: The need for patient consent was waived due to the retrospective nature of the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Dataset is available from the corresponding author by e-mail at xiaotao@ncu.edu.cn.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tao Xiao, MD, Department of General Surgery, First Affiliated Hospital of Nanchang University, No. 17 Yong Wai Zheng Street, Nanchang 330006, Jiangxi Province, China. xiaotao@ncu.edu.cn
Received: October 28, 2024 Revised: January 13, 2025 Accepted: February 12, 2025 Published online: April 27, 2025 Processing time: 154 Days and 16.3 Hours
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.
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.
