Primary Closure and Rate of Bile Leak following Laparoscopic Common Bile Duct Exploration via Choledochotomy

Hua, Jie; Lin, Shengping; Qian, Daohai; He, Zhi-gang; Zhang, Ti; Song, Zhijun

doi:10.1159/000368326

Cited by 45 publications

(39 citation statements)

References 28 publications

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“…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]. In patients with slender CBD, bile leakage occurred more frequently (<1 vs ≥1 cm, 31.6% vs 7.0%, p = 0.04).…”

Section: Discussionsupporting

confidence: 57%

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

et al. 2017

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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.

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Section: Discussionsupporting

confidence: 57%

“…The incidence of bile leakage after primary closure following LCBDE varied dramatically [38–40]. It might be attributed to the different definition of bile leakage after biliary surgery among centers.…”

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

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“…The authors are concerned, however, that there might be selection bias, with larger stones tending to be approached via the CBD. More recent trends towards primary closure without a T‐tube are often limited by the diameter of the bile duct as a risk factor for the leak. The leak, however, is usually of little clinical importance compared with the added morbidity associated with T‐tube or stent insertion.…”

Section: Discussionmentioning

confidence: 99%

Meta‐analysis of laparoscopic transcysticversustranscholedochal common bile duct exploration for choledocholithiasis

et al. 2019

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Background It is not clear whether laparoscopic transcystic exploration (LTCE) laparoscopic choledochotomy (LCD) is superior in the management of choledocholithiasis. In this meta‐analysis, the success of LTCE versus LCD was evaluated. Methods Cochrane Central Register of Controlled Trials, Web of Science, Trip, PubMed, Ovid and Embase databases were searched systematically for relevant literature up to May 2017. Studies that compared the success rate of LTCE and LCD in patients with choledocholithiasis were included. PRISMA guidelines were followed. Multiple independent reviewers contributed on a cloud‐based platform. Random‐effects model was used to calculate odds ratios (ORs) or standardized mean differences (MDs) with 95 per cent confidence intervals. An a priori hypothesis was generated based on clinical experience that LTCE is as successful as LCD. Results Of 3533 screened articles, 25 studies comprising 4224 patients were included. LTCE achieved a lower duct clearance rate than LCD (OR 0.38, 95 per cent c.i. 0·24 to 0·59). It was associated with a shorter duration of surgery (MD −0·86, 95 per cent c.i. −0·97 to −0·77), lower bile leak (OR 0·46, 0·23 to 0·93) and shorter hospital stay (MD −0·78, −1·14 to −0·42) than LCD. There was no statistically significant difference in conversion, stricture formation or reintervention rate. Conclusion LCD has a higher rate of successful duct clearance, but is associated with a longer duration of surgery and hospital stay, and a higher bile leak rate.

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“…Although laparoscopic CBD exploration with primary closure has had extensive global use during the past few decades, it is still trapped in controversy. [6][7][8][9] In 2002, Decker et al 10 conducted a prospective study on primary duct closure in 100 patients. They reported that the incidence of post-operative complications was 11%.…”

Section: Discussionmentioning

confidence: 99%

Primary duct closure combined with transcystic drainage versus T‐tube drainage after laparoscopic choledochotomy

Guan

Jiang

Mao

2019

ANZ Journal of Surgery

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Background We compared the post‐operative course and final outcome of primary duct closure combined with transcystic drainage with those of T‐tube drainage. Methods We retrospectively analysed 112 consecutive patients treated with laparoscopic choledochotomy for common bile duct stones between February 2014 and December 2017. Primary closure with transcystic drainage was performed in 59 patients (group A), and laparoscopic choledochotomy with T‐tube drainage was performed in 53 (group B). The primary endpoints were morbidity, the bile drainage quantity, operative time, post‐operative stay, time until return to work and post‐operative complications. Results The operation was successfully completed in all patients. The return to work period in group A was significantly shorter than that in group B (7.25 ± 1.27 versus 46.47 ± 3.86 days, P < 0.05). The average daily drainage was not significantly different between the two groups (P > 0.05). There was no significant difference in the operation time (133.75 ± 14.51 versus 132.21 ± 12.71 min) and duration of hospital stay (5.15 ± 1.23 versus 5.94 ± 0.95 days) between the two groups (P > 0.05). Bile leakage was seen in one T‐tube removal patient. No complications were reported in group A. The patients were followed for 2 to 29 months (average: 10). Normal liver function and no stricture of the bile duct were detected with ultrasonography. Conclusion Primary closure of choledochotomy and subsequent transcystic drainage is a simple and less invasive procedure than T‐tube placement.

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Primary Closure and Rate of Bile Leak following Laparoscopic Common Bile Duct Exploration via Choledochotomy

Cited by 45 publications

References 28 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

Meta‐analysis of laparoscopic transcysticversustranscholedochal common bile duct exploration for choledocholithiasis

Primary duct closure combined with transcystic drainage versus T‐tube drainage after laparoscopic choledochotomy

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