To investigate the clinical effectiveness of laparoscopic common bile duct exploration (LCBDE) versus endoscopic retrograde cholangiopancreatography combined with endoscopic duodenal sphincterotomy (ERCP+EST) in the treatment of elderly patients with simple common bile duct stones (CBDs), and to analyze the independent risk factors of postoperative complications.

The clinical data of 240 elderly patients with simple CBDs admitted to the First Affiliated Hospital of Xinjiang Medical University from January 2017 to December 2024 were retrospectively analyzed. The patients were divided into the LCBDE group (70 cases) and the ERCP+EST group (170 cases) according to the operation method. The general data of the two groups were matched by the propensity score matching method. Among them, there were 47 cases in the LCBDE group and 88 cases in the ERCP+EST group. The surgical operation-related indicators, including the incidence of postoperative complications, length of hospital stay, and total hospitalization costs, were compared between the two groups. Multivariate Logistic regression analysis was used to analyze the risk factors associated with postoperative complications following two surgical procedures.

The ERCP+EST group had significantly better outcomes (all P<0.01), including shorter operation duration (40.00 min vs 190.00 min), less intraoperative blood loss (2.00 ml vs 50.00 ml), shorter hospitalization stay (6 days vs 13 days), and lower costs (24 768.53 yuan vs 35 699.11 yuan. ICU transfer emerged as an independent risk factor for postoperative complications in the LCBDE group (OR=8.59, 95% CI: 1.75-48.79, P<0.01). Elderly age, cardiovascular disease, and large diameter of common bile duct significantly increased the risk of ICU transfer (P<0.05). Hypertension (OR=2.90, 95% CI: 1.04-8.04) and diabetes mellitus (OR=4.64, 95% CI: 1.16-17.73) were independent risk factors for postoperative complications in the ERCP+EST group (both P<0.05).

In elderly patients with CBDs, LCBDE and ERCP+EST have good safety, while ERCP+EST is superior in terms of operation duration, intraoperative blood loss, hospitalization stay and costs. LCBDE should be avoided in patients with severe cardiovascular disease or bile duct dilation, while ERCP+EST is recommended. For patients with diabetes or hypertension, ERCP+EST should be carefully selected, and the control of blood glucose and blood pressure should be strengthened during the perioperative period.