Published online Aug 27, 2026. doi: 10.4240/wjgs.120366
Revised: April 15, 2026
Accepted: June 3, 2026
Published online: August 27, 2026
Processing time: 144 Days and 11.3 Hours
Choledocholithiasis is highly prevalent among the elderly, with laparoscopic common bile duct exploration (LCBDE) plus laparoscopic cholecystectomy (LC) serving as a key minimally invasive treatment. However, elderly patients often face increased surgical risks and prolonged recovery due to reduced physiological reserve and comorbidities. The enhanced recovery after surgery (ERAS) protocol has proven effective in optimizing perioperative outcomes across multiple sur
To explore the application value of perioperative management based on the ERAS concept in elderly patients undergoing LCBDE combined with LC.
Elderly patients with choledocholithiasis who underwent LCBDE + LC in our hospital from April 2023 to April 2024 were selected. Using a random number table method, a statistician not involved in the study implementation generated a random number sequence using SPSS 27.0 software, which was placed in sealed, opaque envelopes. Upon enrollment, patients opened the envelopes in sequence and were assigned to either the ERAS group or the control group based on the enclosed number, with 40 cases in each group. The control group received conventional perioperative management, while the ERAS group received perioperative management based on the ERAS concept. Comparisons were made between the two groups regarding gastrointestinal function recovery indicators (time to first flatus, total intravenous fluid volume, time to first defecation, time to bowel sound recovery), inflammatory factor levels (high-sensitivity C-reactive protein, interleukin-6, tumor necrosis factor-α), pain status (Visual Analog Scale score, pain duration), complication rate, length of hospital stay, hospitalization costs, readmission rate, quality of life (Short Form-36 Health Survey), and satisfaction.
On postoperative day 3, high-sensitivity C-reactive protein (73.37 ± 8.73 mg/L), interleukin-6 (41.29 ± 4.74 pg/mL), tumor necrosis factor-α (0.75 ± 0.12 pg/mL), Visual Analog Scale score, and pain duration in the ERAS group were lower than those in the control group (P < 0.05). The ERAS group also showed shorter times to first flatus (38.56 ± 4.65 hours), bowel sound recovery (21.95 ± 3.22 hours), and first defecation (2.75 ± 0.63 days), lower total intravenous fluid volume (6.54 ± 0.57 L), lower overall complication rate (5.00%), lower readmission rate (2.50%), shorter hospital stay (9.25 ± 0.71 days), and lower hospitalization costs (2.51 ± 0.77 ten thousand CNY) compared to the control group. Furthermore, Short Form-36 Health Survey scores across all dimensions and satisfaction rate (95.00%) were higher in the ERAS group than in the control group (P < 0.05).
Perioperative management based on the ERAS concept can promote gastrointestinal recovery, reduce inflammation levels, improve pain status, lower complication rates, decrease hospitalization costs and readmission rates, and enhance quality of life and satisfaction in elderly patients with choledocholithiasis after LCBDE + LC.
Core Tip: In elderly patients undergoing laparoscopic common bile duct exploration combined with cholecystectomy, perioperative management guided by the enhanced recovery after surgery concept significantly enhances recovery by accelerating gastrointestinal function, reducing inflammation and pain, lowering complication and readmission rates, shortening hospital stay, decreasing costs, and improving overall quality of life and satisfaction.