Learning curve and outcome of laparoscopic transcystic common bile duct exploration for choledocholithiasis

Zhu, Jiegao; Han, Wei; Guo, Wei; Su, Wen; Bai, Zhigang; Zhang, Z T

doi:10.1002/bjs.9922

Cited by 49 publications

(27 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In experienced hands, the incidence of bile leakage decreased significantly form 15.7% to 7.0% ( p = 0.04). The data form LC, LCBDE and LCTBDE also revealed the importance of surgeon’s experience for decreasing the complication rate [24, 26, 43]. Another factor affecting the incidence of bile leakage was the diameter of CBD, which was in accordance with Hua’s study [40].…”

Section: Discussionsupporting

confidence: 57%

“…Recent report from Zhu demonstrated that in their 708 patients, LTCBDE could be successfully applied in more than 90% patients and with high clearance rate (common bile duct stones residual in 13 patients) and low complication rate (postoperative complications in 27 patients). So they conclude that LTCBDE with or without microincision and/or lithotripsy is a safe and effective approach in treatment of CBD stones [24]. However, the ability to remove stones is restricted by the diameter of cystic duct, even with application of electrohydraulic lithotripsy.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Risk factors for bile leakage after primary closure following laparoscopic common bile duct exploration: a retrospective cohort study

et al. 2017

View full text Add to dashboard Cite

AbstractionBackgroundPrimary closure following laparoscopic common bile duct exploration (LCBDE) has been widely adopted because of the efficacy and safety in treatment of common bile duct (CBD) stones. However, the risk factors for bile leakage, the most common complication after primary closure, has not been clarified yet.MethodsA retrospective cohort study of patients who underwent LCBDE with primary closure after choledochotomy between Feb. 2012 and Jun. 2016 was performed. Risk factors for bile leakage were identified by logistic regression inculding demographic factors, preoperative condition and surgical details.ResultsBetween Feb. 2012 and Jun. 2016, a total of 265 LCBDE procedures were applied in our hospital and 141 patients with primary closure were included in this study. Bile leakage occurred in 11.3% (16/141) of these patients, and happened more frequently in patients with slender CBD (<1 vs ≥1 cm, 31.6% vs 7.0%, p = 0.04) and those managed by inexperienced surgeons (initial 70 cases vs later cases, 17.1% vs 5.6%, p = 0.04). After multivariable regression, the diameter of CBD [OR 95% CI, 3.799 (1.081–13.349), p = 0.04] and experience of surgeons [OR 95% CI, 4.228 (1.330–13.438), p = 0.03] were significantly related to bile leakage.ConclusionSlender CBD and inexperienced surgeons were the high risk factors for bile leakage after primary closure following LCBDE.

show abstract

Section: Discussionsupporting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Risk factors for bile leakage after primary closure following laparoscopic common bile duct exploration: a retrospective cohort study

et al. 2017

View full text Add to dashboard Cite

show abstract

“…To obtain the learning curve, based on prior data that most learning curves assume a power-law relationship, we applied a power-law curve model (y = a1x –a2 ) to the abstracted learning data (i.e., operating time vs. case number) – both the power-law value and the predicted value from the multivariable model – and we examined the curves to identify where the learning curve stabilized [9, 10]. Logistic regression analyses were used to evaluate the length of operation of both procedures.…”

Section: Methodsmentioning

confidence: 99%

Comparison of Single-Incision Laparoscopic Cholecystectomy versus Needlescopic Cholecystectomy: A Single Institutional Randomized Clinical Trial

Umemura

Sakai²,

Nakamura³

et al. 2018

Dig Surg

View full text Add to dashboard Cite

Background: Both single-incision laparoscopic cholecystectomy (SILC) and needlescopic cholecystectomy (NSC) are superior to conventional laparoscopic cholecystectomy in terms of cosmetic outcome and incisional pain. We conducted a prospective, randomized clinical trial to evaluate the surgical outcome, postoperative pain, and cosmetic outcome for SILC and NSC procedures. Methods: In this trial, 105 patients were enrolled (52 in the SILC group; 53 in the NSC group). A visual analogue scale (VAS) was used to evaluate the cosmetic outcome and incisional pain for patients. Logistic regression analyses were used to evaluate the operative difficulty that was present for both procedures. Results: There were no significant differences in patient characteristics or surgical outcomes, including operative time and blood loss. The mean VAS scores for cosmetic satisfaction were similar in both groups. There were significant differences in the mean VAS scores for incisional pain on postoperative day 1 (p = 0.009), and analgesics were required within 12 h of surgery (p = 0.007). Obesity (body mass index ≥25 kg/m²) was the only significant influential factor for operating time over 100 min (p = 0.031). Conclusion: NSC is superior to SILC in terms of short-term incisional pain. Experienced laparoscopic surgeons can perform both SILC and NSC without an increase in operative time.

show abstract

“…Feng et al performed a meta-analysis of almost 3000 patients and demonstrated that TC LCBDE had a lower biliary complication rate and shorter hospital stay compared to TD LCBDE [7]. They key issues with choledochotomy and TD LCBDE relate to loss of CBD integrity, resulting in higher incidences of bile leak and haemobilia/blood loss, the need for T-tube insertion (with corresponding complications such as electrolyte imbalance) and the need for further invasive intervention [8].…”

Section: Introductionmentioning

confidence: 99%

Holmium laser lithotripsy improves the rate of successful transcystic laparoscopic common bile duct exploration

Jones

Musawi

Navaratne

et al. 2019

Langenbecks Arch Surg

View full text Add to dashboard Cite

Purpose Transcystic laparoscopic common bile duct exploration (LCBDE) seems safer than transductal LCBDE and is associated with fewer biliary complications. It has traditionally been limited to smaller bile duct stones however. This study aimed to assess the ability of laser-assisted bile duct exploration by laparoendoscopy (LABEL) to increase the rate of successful transcystic LCBDE in patients with bile duct stones at the time of laparoscopic cholecystectomy. Methods Patients undergoing LCBDE between 2014 and 2018 were retrospectively analysed. Baseline demographic and medical characteristics were recorded, as well as intra-operative findings and post-procedure outcomes. Standard LCBDE via the transcystic route was initially attempted in all patients, and LABEL was only utilised if there was failure to achieve transcystic duct clearance. The transductal route was utilised for failed transcystic extraction. Results One hundred and seventy-nine consecutive patients underwent LCBDE; 119 (66.5%) underwent unaided transcystic extraction, 29 (16.2%) required LABEL to achieve transcystic extraction and 31 (17.3%) failed transcystic extraction (despite the use of LABEL in 7 of these cases) and hence required conversion to transductal LCBDE. As such, LABEL could be considered to increase the rate of successful transcystic extraction from 66.5% (119/179) to 82.7% (148/179). Patients requiring LABEL were however more likely to experience major complications (CD III-IV 5.6% vs 0.7%, p = 0.042) although none were specifically attributable to the laser intra-operatively. Conclusions LABEL is an effective adjunct to LCBDE that improves the rate of successful transcystic extraction.

show abstract

Learning curve and outcome of laparoscopic transcystic common bile duct exploration for choledocholithiasis

Abstract: LTCBDE with or without microincision and/or lithotripsy is a safe and effective approach.

Cited by 49 publications

References 27 publications

Risk factors for bile leakage after primary closure following laparoscopic common bile duct exploration: a retrospective cohort study

Risk factors for bile leakage after primary closure following laparoscopic common bile duct exploration: a retrospective cohort study

Comparison of Single-Incision Laparoscopic Cholecystectomy versus Needlescopic Cholecystectomy: A Single Institutional Randomized Clinical Trial

Holmium laser lithotripsy improves the rate of successful transcystic laparoscopic common bile duct exploration

Contact Info

Product

Resources

About