Primary Closure Following Laparoscopic Common Bile Duct Reexploration for the Patients Who Underwent Prior Biliary Operation

Abstract

To assess feasibility of primary closure following laparoscopic common bile duct reexploration for the patients who underwent prior biliary operation, we retrospectively studied 50 patients with recurrent or residual common bile duct (CBD) stones who underwent laparoscopic biliary reoperation between June 2008 and June 2013. Endoscopic sphincterotomy (EST) was treated for all these patients and validated failed. They were divided into two groups. Primary closure following laparoscopic common bile duct exploration (LCBDE) was performed in 25 cases (group A); LCBDE plus T-tube drainage was performed in others (group B). The items of operation were compared. The duration of the operation in group A was shorter than that in group B (141 ± 85 vs 158 ± 71 min, p < 0.05), as was postoperative hospital stay (16 ± 2.3 vs 23 ± 2.3 h, p < 0.05) and the times of postoperative gastrointestinal function recovery (16 ± 2.3 vs 23 ± 2.3 h, p < 0.05). Just one duodenum was damaged in group B. Postoperative clinically significant bile leakage occurred in two patients in group A and one case in group B. The median follow-up was 18 months. No postoperative pancreatitis, postoperative bleeding, bile peritonitis after T-tube removal, stricture of bile duct, and death occurred in the two groups. Just two cases in group B were verified residual stones after 1 month. Primary closure following laparoscopic common bile duct reexploration for the patients who underwent prior biliary operation appears to be a minimally invasive, safe, feasible, and effective procedure when done by expert laparoscopic surgeons.

T-Tube Use After Laparoscopic Common Bile Duct Exploration

“…Eleven studies 23,26,28,30,33,37–40,41,43 that compared PDC with TTD investigated recurrent CBD stones during the follow-up period; in 5 studies, 26,28,33,37,43 11/759 (1.4%) patients in the PDC group and 10/662 (1.5%) patients in the TTD group had recurrent CBD stones during the follow-up period. However, no significant difference was discovered (Peto OR = 0.92, 95% CI = 0.38–2.24, P = .86; no heterogeneity was found; I 2 = 0%, P = .66) ( Figure 4C ).…”

“…Twelve studies 9,23,26,30,33,34,37–40,41,43 reported the duration of postoperative hospital stay; the PDC group had a significantly shorter hospital stay duration (weighted mean differences. −2.89, 95% CI =−3.96 to 1.82, P < .00001; a heterogeneity was found; I 2 = 96%, P < .00001) ( Figure 5C ).…”

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

“…[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.…”

“…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.…”