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Laparoscopic common bile duct exploration in patients with previous abdominal biliary tract operations.
- Source :
-
Surgical Endoscopy & Other Interventional Techniques . Apr2020, Vol. 34 Issue 4, p1551-1560. 10p. 4 Charts. - Publication Year :
- 2020
-
Abstract
- <bold>Background: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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).<bold>Conclusion: </bold>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]
- Subjects :
- *BILIARY tract
*BILE ducts
*GALLBLADDER
*CHOLANGITIS
*INTRA-abdominal infections
*BLOOD loss estimation
*SURGICAL complications
*OPERATIVE surgery
*ABDOMINAL 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
*LAPAROSCOPIC common bile duct exploration
BILE duct surgery
BILIARY tract surgery
Subjects
Details
- Language :
- English
- ISSN :
- 18666817
- Volume :
- 34
- Issue :
- 4
- Database :
- Academic Search Index
- Journal :
- Surgical Endoscopy & Other Interventional Techniques
- Publication Type :
- Academic Journal
- Accession number :
- 142412736
- Full Text :
- https://doi.org/10.1007/s00464-020-07429-3