Cholecystectomy for combined choledocholithiasis and cholelithiasis in elderly patients: do we need it?

Background
After endoscopic common bile duct (CBD) stone removal, physicians always recommend prophylactic cholecystectomy even in the absence of gall bladder (GB) stones to prevent further complications such as acute cholecystitis, recurrent CBD stones, or cholangitis despite the fact that management of GB after endoscopic stone removal remains a matter of debate. The main options in managing concomitant CBD stones and the GB stones include selective preoperative endoscopic retrograde cholangiopancreatography (ERCP), postoperative ERCP, open explorations, and laparoscopic common bile duct exploration.
Aim
The aim of this study was to assess the need for cholecystectomy after endoscopic sphincterotomy for CBD stones in elderly patients aged more than or equal to 70 years with coexisting cholelithiasis.
Patients and methods
A total of 336 patients who underwent successful endoscopic CBD stone removal at the endoscopy unit of the Medical Research Institute Hospital, Alexandria University from January 2013 to December 2015, were analyzed retrospectively. Patients were divided into three groups: the in-situ group comprised 168 patients with an intact GB, the cholecystectomy group comprised 72 patients who had cholecystectomy performed after ERCP, and the third group comprised 36 patients who had cholecystectomy before ERCP.
Results
After endoscopic CBD stone removal, 72 (30%) patients underwent subsequent cholecystectomy and 168 (70%) patients did not. There was no significant difference as regards morbidity and mortality among the study groups. Age was not a contraindication for surgery; however, the presence of multiple comorbidities, mainly diabetes and cardiac diseases, was a significant contraindication for prophylactic cholecystectomy.
Conclusion
A wait-and-see policy may be recommended for elderly patients with comorbidities and GB taking in consideration regular follow-up for early detection of acute biliary complications.