Reinterventions following laparoscopic cholecystectomy and bile duct exploration. A review of prospective data from 5740 patients

Abstract

Background Complications following laparoscopic cholecystectomy (LC) and common bile duct exploration (CBDE) for the management of gallstones or choledocholithiasis impact negatively on patients’ quality of life and may lead to reinterventions. This study aims to evaluate the causes and types of reintervention following index admission LC with or without CBDE. Methods A prospectively maintained database of LC and CBDE performed by a single surgeon was analysed. Preoperative factors, difficulty grading and perioperative complications requiring reintervention and readmissions were examined. Results Reinterventions were required in 112 of 5740 patients (2.0%), 89 (1.6%) being subsequent to complications. The reintervention cohort had a median age of 64 years, were more likely to be females (p < 0.0023) and to be emergency admissions (67.9%, p < 0.00001) with obstructive jaundice (35.7%, p < 0.00001). 46.4% of the reintervention cohort had a LC operative difficulty grade IV or V and 65.2% underwent a CBDE. Open conversion was predictive of the potential for reintervention (p < 0.00001). The most common single cause of reintervention was retained stones (0.5%) requiring ERCP followed by bile leakage (0.3%) requiring percutaneous drainage, ERCP and relaparoscopy. Relaparoscopy was necessary in 17 patients and open surgery in 13, 6 of whom not resulting from complications. There were 5 deaths. Conclusion This large series had a low incidence of reinterventions resulting from complications in spite of a high workload of index admission surgery for biliary emergencies and bile duct stones. Surgical or endoscopic reinterventions following LC alone occurred in only 0.8%. The most common form of reintervention was ERCP for retained CBD stones. This important outcome parameter of laparoscopic biliary surgery can be optimised through early diagnosis and timely reintervention for complications.

The incidence, operative difficulty and outcomes of staged versus index admission laparoscopic cholecystectomy and bile duct exploration for all comers: a review of 5750 patients

“…This study shows that IAC has a lower incidence of perioperative ERCP when compared to delayed cholecystectomy (0.9% vs. 8.9%) and this is consistent with the results of the Zhong et al meta-analysis (2433 patients in 17 studies addressing ERCP usage) [19]. The safety of this single-stage approach with a high-volume emergency workload has previously been demonstrated [10].…”

“…However, this was not associated with a higher Clavien-Dindo classification, a greater risk of requiring re-operation, 30-day readmissions or a higher 30-day mortality rate. Fifty patients with Clavien-Dindo grade 3a complications include an incidence of post-cholecystectomy bile leakage and retained stones which has been presented in detail in previous studies [9,10]. Within these 50 there were also four patients with postoperative collections drained percutaneously, two pneumothoraces (one due to intraoperative iatrogenic diaphragm injury and one from anaesthetic regional nerve blockade) managed by chest drain insertion and two patients with postoperative symptomatic pancreatitis.…”

Current management of concomitant cholelithiasis and common bile duct stones

“…When ERCP-ES is not possible for various reasons, a reliable alternative is the percutaneous management of CBD stones that is feasible and safe[ 3 ]. Reinterventions in stone recurrence, mainly ERCP or surgical (laparoscopic or open), may be needed[ 63 ].…”

Retrospective evaluation of “critical view of safety” in laparoscopic cholecystectomy

“…Before reviewing the video, according to Professor Strasberg's viewpoint, the scoring criteria were established. (1) Only surgeries that simultaneously meet the following three concerns are considered to meet CVS requirements: thoroughly clean adipose tissue and brous tissue around the gallbladder triangle, and completely expose the gallbladder triangle; Separate the bottom 1/3 of the gallbladder bed and fully expose the gallbladder plane; There are only two ducts (cystic duct and cystic artery) in the eld of vision that connect the gallbladder and the liver duodenal ligament tissue. (2) For the above three points, each point is assigned a score based on the standard of "not executed=0 point, partially executed=1 point, executed=2 point", and the total score of the three points is the nal score.…”

“…Laparoscopic cholecystectomy (LC) has become the standard surgical procedure for benign gallbladder disease. Although this technique has become more mature and widely developed, bile duct injury (BDI) still occurs frequently, causing biliary peritonitis, biliary duct stenosis, biliary cirrhosis, and even bringing huge physical, psychological, economic burdens to patients and their families [1,2] . In order to reduce the BDI occurrence and implement LC more safely, the CVS has gradually become the LC standard process [3] , and is considered as an important guarantee for the prevention of BDI.…”