Laparoscopic Common Bile Duct Exploration Versus Open Approach in Cirrhotic Patients with Choledocholithiasis: A Retrospective Study

Abstract

LCBDE can be safely performed in patients with Child-Pugh A or B cirrhosis and choledocholithiasis, with considerable efficiency, minimal short-term complications, and acceptable long-term outcomes. LCBDE has the advantages over open CBD exploration of less bleeding and reduced length of hospital stay.

Laparoscopic Exploration of the Common Bile Duct: A Systematic Review of the Published Evidence Over the Last 10 Years

“…Studies that compared the operative time between LCBDE and OCBDE showed mixed results that mostly were statistically insignificant. 22,25,32,33,53 On the other hand, laparoscopic transcystic approach has been reported to have shorter mean operative time than the laparoscopic transductal approach as we have discussed earlier in the text.…”

“…The referencing order of the studies included in Table 2 starts from the most recently published papers. 19-54 Grading of the reviewed evidence was based on the content of Table 3. Statistical difference significance was considered to be P ≤ .05.…”

“…These findings were statistically significant in the majority of the studies. [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36]38 This reduction in bile leak rates associated with LCBDE that was reported in the more recent studies could be explained by the accumulative experiences, the improvements in learning curves, and the patients' selection process. The reviewed studies have also shown that the laparoscopic transcystic approach has lower associated bile leak rates (0%-3.2%) when compared to the laparoscopic transductal approach (0%-12%).…”

“…19,28,31,36,38,39 The studies that compared the rate of bile leak between LCBDE in general and OCBDE did not show statistically significant differences. 22,25,32,33,53 Morbidity. A wide range of 0.9%-23.8% of various overall postoperative complications, like cardiopulmonary complications, thromboembolism, wound infection, and bile leak, which we have discussed earlier in the text, were associated with CBD exploration in the reviewed studies.…”

Comparison of open, laparo-endoscopic and one-stage laparoscopic approaches for treatment of gallbladder and common bile duct stones

“…[5] However, some recent studies proved laparoscopic CBD exploration to be successful in older and cirrhotic patients. [22][23][24] Among our patients, serious secondary conditions were observed in 28.3% cases, including pregnancy in four patients, cirrhosis in four patients and older age in seven patients, and no complication was identified regarding such conditions. Impacted stones comprise the main reasons of failures both in laparoscopic and endoscopic managements.…”