1. Laparoscopic common bile duct exploration in patients with previous abdominal biliary tract operations.
- Author
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Li, Min, Tao, Ying, Shen, Sheng, Song, Lujun, Suo, Tao, Liu, Han, Wang, Yueqi, Zhang, Dexiang, Ni, Xiaoling, and Liu, Houbao
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BILIARY tract ,BILE ducts ,GALLBLADDER ,CHOLANGITIS ,INTRA-abdominal infections ,BLOOD loss estimation ,SURGICAL complications ,OPERATIVE surgery ,ABDOMINAL surgery ,BILE duct surgery ,GALLSTONES ,LENGTH of stay in hospitals ,TISSUE adhesions ,RESEARCH ,RESEARCH methodology ,RETROSPECTIVE studies ,EVALUATION research ,TREATMENT effectiveness ,COMPARATIVE studies ,LAPAROSCOPY ,POSTOPERATIVE period ,RESEARCH funding ,BILIARY tract surgery ,LAPAROSCOPIC common bile duct exploration - Abstract
Background: A history of abdominal biliary tract surgery has been identified as a relative contraindication for laparoscopic common bile duct exploration (LCBDE), and there are very few reports about laparoscopic procedures in patients with a history of abdominal biliary tract surgery.Methods: We retrospectively reviewed the clinical outcomes of 227 consecutive patients with previous abdominal biliary tract operations at our institution between December 2013 and June 2019. A total of 110 consecutive patients underwent LCBDE, and 117 consecutive patients underwent open common bile duct exploration (OCBDE). Patient demographics and perioperative variables were compared between the two groups.Results: The LCBDE group performed significantly better than the OCBDE group with respect to estimated blood loss [30 (5-700) vs. 50 (10-1800) ml; p = 0.041], remnant common bile duct (CBD) stones (17 vs. 28%; p = 0.050), postoperative hospital stay [7 (3-78) vs. 8.5 (4.5-74) days; p = 0.041], and time to oral intake [2.5 (1-7) vs. 3 (2-24) days; p = 0.015]. There were no significant differences in the operation time [170 (60-480) vs. 180 (41-330) minutes; p = 0.067]. A total of 19 patients (17%) in the LCBDE group were converted to open surgery. According to Clavien's classification of complications, the LCBDE group had significantly fewer postoperative complications than the OCBDE group (40 vs. 57; p = 0.045). There was no mortality in either group. Multiple previous operations (≥ 2 times), a history of open surgery, and previous biliary tract surgery (including bile duct or gallbladder + bile duct other than cholecystectomy alone) were risk factors for postoperative adhesion (p = 0.000, p = 0.000, and p = 0.000, respectively).Conclusion: LCBDE is ultimately the least invasive, safest, and the most effective treatment option for patients with previous abdominal biliary tract operations and is especially suitable for those with a history of cholecystectomy, few previous operations (< 2 times), or a history of laparoscopic surgery. [ABSTRACT FROM AUTHOR]- Published
- 2020
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