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01-09-2017

Five hundred consecutive laparoscopic common bile duct explorations: 5-year experience at a single institution

Authors: Jie Hua, Hongbo Meng, Le Yao, Jian Gong, Bin Xu, Tingsong Yang, Wei Sun, Yuxiang Wang, Yukan Mao, Ti Zhang, Bo Zhou, Zhenshun Song

Published in: Surgical Endoscopy | Issue 9/2017

Abstract

Background

Laparoscopic common bile duct exploration (LCBDE) has gained wide popularity in the treatment of choledocholithiasis. Bile leakage remains a major cause of postoperative morbidity. The aim of this study was to report 5-year results of 500 LCBDEs and identify risk factors associated with bile leakage.

Methods

Five hundred consecutive LCBDEs performed in one institution from September 2011 to June 2016 were reviewed. Patients’ clinical data were retrospectively collected and analyzed. Univariable and multivariable analysis of bile leakage was performed by logistic regression.

Results

We found stones (n = 388) or bile sludge (n = 71) in 459 patients (92%) on exploration, leaving 41 patients (8%) without stones. Operative time was 128 min in the first 250 LCBDEs, and this decreased to 103 min in the second 250 LCBDEs (P = 0.0004). Four hundred and eight (82%) procedures were completed with primary closure after choledochotomy; the rate of primary closure increased significantly in the second 250 patients compared with the first (88 vs 76%; P = 0.0005), whereas T-tube placement (2 vs 6%; P = 0.0225) and transcystic approach (7 vs 12%; P = 0.0464) decreased, respectively. Stone clearance was successful in 495 patients (99%). Overall morbidity was 5%, and bile leakage occurred in 17 patients (3.4%). Two patients died from bile leakage. The median follow-up was 24 months with stone recurrence occurred in two patients and bile duct stricture in one patient. Univariable analysis identified diameter of the common bile duct (CBD), stone clearance, and T-tube insertion as risk factors related to bile leakage. Multivariable analysis taking these three factors into account identified non-dilated CBD (risk ratio (RR) = 9.87; P = 0.007) and failure in stone clearance (RR = 11.88; P = 0.024) as significant risk factors.

Conclusions

Bile leakage following LCBDE is associated with diameter of the CBD and stone clearance. LCBDE would be safer in proficient laparoscopic surgeons with a careful selection of patients.

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Title: Five hundred consecutive laparoscopic common bile duct explorations: 5-year experience at a single institution
Authors: Jie Hua
Hongbo Meng
Le Yao
Jian Gong
Bin Xu
Tingsong Yang
Wei Sun
Yuxiang Wang
Yukan Mao
Ti Zhang
Bo Zhou
Zhenshun Song
Publication date: 01-09-2017
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 9/2017
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-016-5388-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Five hundred consecutive laparoscopic common bile duct explorations: 5-year experience at a single institution

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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