Laparoscopic common bile duct exploration with primary closure is beneficial for patients with previous upper abdominal surgery
- 1 March 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in Surgical Endoscopy
- Vol. 36 (2), 1053-1063
- https://doi.org/10.1007/s00464-021-08371-8
Abstract
Background Previous upper abdominal surgery (PUAS) is considered a contraindication to laparoscopic surgery. Whether LCBDE-PC is feasible and beneficial for patients with PUAS remains unclear. This study aimed to evaluate the feasibility and benefits of LCBDE-PC for patients with PUAS. Methods From June 2011 to September 2019, 1167 patients who underwent laparoscopic procedures for choledocholithiasis were reviewed retrospectively. Perioperative outcomes were compared between patients with and without PUAS in un-matched and matched cohorts. Results LCBDE-PC was performed successfully in 88.3% of patients with PUAS, and 92.5% of patients without PUAS (P > 0.05). Multivariate analysis showed that PUAS was not a risk factor that affected successful performance of LCBDE-PC. Although a higher rate of conversion to open surgery and longer operative time were observed in patients with PUAS, no significant differences were found between patients with and without PUAS in multivariate and propensity score analysis (P > 0.05). A predictive nomogram for LCBDE-PC failure was developed based on potential predictors from the least absolute shrinkage and selection operator (LASSO) regression model. Successful performance of LCBDE-PC was associated with operative time. A linear regression model for operative time showed impacted stone in the CBD and intraoperative laser use was the most important factor in determining the operative time. Conclusion LCBDE-PC is feasible and beneficial for patients with PUAS. However, patients with PUAS with a high possibility of LCBDE-PC failure from the nomogram and a longer operative time from the linear regression model should be cautious when undergoing LCBDE-PC.Keywords
Funding Information
- Natural Science Foundation of Shanghai (18ZR1429600)
This publication has 34 references indexed in Scilit:
- Defining Treatment and Outcomes of Hepaticojejunostomy Failure Following PancreaticoduodenectomyJournal of Gastrointestinal Surgery, 2013
- Laparoscopic common bile duct exploration for elderly patients: as a first treatment strategy for common bile duct stonesJournal of the Korean Surgical Society, 2011
- Laparoscopy-assisted Gastrectomy for Patients With Earlier Upper Abdominal Open SurgerySurgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2010
- Laparoscopic Exploration of Common Bile Duct with Primary Closure Versus T-Tube Drainage: A Randomized Clinical TrialJournal of Surgical Research, 2009
- Trend towards Primary Closure Following Laparoscopic Exploration of the Common Bile DuctThe Annals of The Royal College of Surgeons of England, 2008
- Efficacy and Safety of Early Laparoscopic Common Bile Duct Exploration as Primary Procedure in Acute Cholangitis Caused by Common Bile Duct StonesJournal of Laparoendoscopic & Advanced Surgical Techniques, 2007
- Impact of previous abdominal surgery on laparoscopic appendectomy for acute appendicitisSurgical Endoscopy, 2006
- Previous abdominal operations do not affect the outcomes of laparoscopic colorectal surgerySurgical Endoscopy, 2004
- Laparoscopic cholecystectomy in patients with previous upper or lower abdominal surgerySurgical Endoscopy, 2004
- One hundred laparoscopic choledochotomies with primary closure of the common bile ductSurgical Endoscopy, 2003