Laparoscopic common bile duct exploration in patients with previous abdominal biliary tract operations

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.

Laparoscopic common bile duct exploration for patients with a history of prior biliary surgery: a comparative study with an open approach

“…19 However, there are few reports of surgical outcomes comparing LCBDE with OCBDE in patients with a history of prior biliary surgery. 20 In the present study, 162 patients with previous biliary operation had undergone reoperation, 72 of them were laparoscopic approach, and the remaining 90 were open surgery. The stone clearance rate in the LCBDE group and OCBDE groups were 97.2% and 96.7%, respectively, and there was no statistical significance between the two groups.…”

“…[11][12][13][14] With the development of laparoscopic equipment and technology, there are a few studies have reported data on the application of LCBDE to patients after cholecystectomy and/or common bile duct exploration. [16][17][18][19][20] For all that, LCBDE has not been widely employed due to the technical challenge for CBDS in those patients. It is still unknown whether LCBDE is as feasible and safe as OCBDE for CBDS in patients with a history of prior biliary surgery.…”

“…24 Two or more previous operations, a history of laparotomy and biliary surgery, were more helpful to the formation of postoperative adhesion. 20 Generally, the degree and range of postoperative adhesion after abdominal operation cannot be predicted. Because of the complexity of postoperative adhesion, the laparoscopic approach is not recommended for bile duct reoperation.…”

“…Several studies have indicated that the feasibility and safety of laparoscopic reoperation in small numbers of patients. [16][17][18][19][20] In 2008, Li et al evaluated the surgical outcomes of 39 patients with retained or recurrent stones treated with laparoscopic reoperation and stated that the stone clearance rate was 94.9%, and overall complications rate was 7.7%. The author concluded that laparoscopic biliary tract reoperation was a safe and feasible procedure if it is performed by experienced surgeons.…”

“…With the development of laparoscopic devices and technology, the learning curve of surgeons, 15 and LCBDE used to treat patients with a history of prior biliary surgery have been reported. [16][17][18][19][20] However, this laparoscopic approach has not been widely employed due to the technical challenge for CBDS in those patients, and further research is needed to evaluate the treatment outcomes of this surgery. Thus, this retrospective study was performed to assess the safety and effectiveness of LCBDE in patients with a history of prior biliary surgery by comparing its clinical outcomes with that of OCBDE.…”