Risk Factors for Bile Leakage After Primary Closure Following Laparoscopic Common Bile Duct Exploration: a Retrospective Cohort Study

Overview

Journal BMC Surg

Publisher Biomed Central

Specialty General Surgery

Date 2017 Jan 7

PMID 28056934

Citations 22

Authors

Dongbin Liu

Feng Cao

Jiafeng Liu

Dahua Xu

Yuehua Wang

Fei Li

Affiliations

Soon will be listed here.

Abstract

Background: Primary 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.

Methods: A 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.

Results: Between 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.

Conclusion: Slender CBD and inexperienced surgeons were the high risk factors for bile leakage after primary closure following LCBDE.

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References

Zhu J, Han W, Guo W, Su W, Bai Z, Zhang Z . Learning curve and outcome of laparoscopic transcystic common bile duct exploration for choledocholithiasis. Br J Surg. 2015; 102(13):1691-7. DOI: 10.1002/bjs.9922. View

Overby D, Apelgren K, Richardson W, Fanelli R . SAGES guidelines for the clinical application of laparoscopic biliary tract surgery. Surg Endosc. 2010; 24(10):2368-86. DOI: 10.1007/s00464-010-1268-7. View

Stoker M . Common bile duct exploration in the era of laparoscopic surgery. Arch Surg. 1995; 130(3):265-8; discussion 268-9. DOI: 10.1001/archsurg.1995.01430030035005. View

Rhodes M, SUSSMAN L, Cohen L, Lewis M . Randomised trial of laparoscopic exploration of common bile duct versus postoperative endoscopic retrograde cholangiography for common bile duct stones. Lancet. 1998; 351(9097):159-61. DOI: 10.1016/s0140-6736(97)09175-7. View

Costi R, Mazzeo A, Tartamella F, Manceau C, Vacher B, Valverde A . Cholecystocholedocholithiasis: a case-control study comparing the short- and long-term outcomes for a "laparoscopy-first" attitude with the outcome for sequential treatment (systematic endoscopic sphincterotomy followed by laparoscopic.... Surg Endosc. 2009; 24(1):51-62. DOI: 10.1007/s00464-009-0511-6. View

Jameel M, Darmas B, Baker A . Trend towards primary closure following laparoscopic exploration of the common bile duct. Ann R Coll Surg Engl. 2008; 90(1):29-35. PMC: 2216713. DOI: 10.1308/003588408X242295. View

Parra-Membrives P, Martinez-Baena D, Lorente-Herce J, Jimenez-Vega J . Laparoscopic common bile duct exploration in elderly patients: is there still a difference?. Surg Laparosc Endosc Percutan Tech. 2014; 24(4):e118-22. DOI: 10.1097/SLE.0b013e31829012f6. View

Yi H, Hong G, Min S, Lee H . Long-term Outcome of Primary Closure After Laparoscopic Common Bile Duct Exploration Combined With Choledochoscopy. Surg Laparosc Endosc Percutan Tech. 2015; 25(3):250-3. DOI: 10.1097/SLE.0000000000000151. View

Aawsaj Y, Light D, Horgan L . Laparoscopic common bile duct exploration: 15-year experience in a district general hospital. Surg Endosc. 2015; 30(6):2563-6. DOI: 10.1007/s00464-015-4523-0. View

10.

Seo Y, Moon J, Choi H, Kim D, Ha J, Lee T . Comparison of endoscopic papillary balloon dilation and sphincterotomy in young patients with CBD stones and gallstones. Dig Dis Sci. 2013; 59(5):1042-7. DOI: 10.1007/s10620-013-2949-6. View

11.

Ambreen M, Shaikh A, Jamal A, Qureshi J, Dalwani A, Memon M . Primary closure versus T-tube drainage after open choledochotomy. Asian J Surg. 2009; 32(1):21-5. DOI: 10.1016/S1015-9584(09)60004-X. View

12.

Ha J, Tang C, Siu W, Chau C, Li M . Primary closure versus T-tube drainage after laparoscopic choledochotomy for common bile duct stones. Hepatogastroenterology. 2004; 51(60):1605-8. View

13.

Wills V, Gibson K, Karihaloot C, Jorgensen J . Complications of biliary T-tubes after choledochotomy. ANZ J Surg. 2002; 72(3):177-80. DOI: 10.1046/j.1445-2197.2002.02308.x. View

14.

Muzaffar I, Zula P, Yimit Y, Jaan A, Wen H . Randomized comparison of postoperative short-term and mid-term complications between T-tube and primary closure after CBD exploration. J Coll Physicians Surg Pak. 2014; 24(11):810-4. DOI: 11.2014/JCPSP.810814. View

15.

Bansal V, Misra M, Rajan K, Kilambi R, Kumar S, Krishna A . Single-stage laparoscopic common bile duct exploration and cholecystectomy versus two-stage endoscopic stone extraction followed by laparoscopic cholecystectomy for patients with concomitant gallbladder stones and common bile duct stones: a.... Surg Endosc. 2013; 28(3):875-85. DOI: 10.1007/s00464-013-3237-4. View

16.

Rogers S, Cello J, Horn J, Siperstein A, Schecter W, Campbell A . Prospective randomized trial of LC+LCBDE vs ERCP/S+LC for common bile duct stone disease. Arch Surg. 2010; 145(1):28-33. DOI: 10.1001/archsurg.2009.226. View

17.

AlHamdani A, Mahmud S, Jameel M, Baker A . Primary closure of choledochotomy after emergency laparoscopic common bile duct exploration. Surg Endosc. 2008; 22(10):2190-5. DOI: 10.1007/s00464-008-0021-y. View

18.

Gupta N . Role of laparoscopic common bile duct exploration in the management of choledocholithiasis. World J Gastrointest Surg. 2016; 8(5):376-81. PMC: 4872066. DOI: 10.4240/wjgs.v8.i5.376. View

19.

Trikudanathan G, Arain M, Attam R, Freeman M . Advances in the endoscopic management of common bile duct stones. Nat Rev Gastroenterol Hepatol. 2014; 11(9):535-44. DOI: 10.1038/nrgastro.2014.76. View

20.

Koch M, Garden O, Padbury R, Rahbari N, Adam R, Capussotti L . Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery. 2011; 149(5):680-8. DOI: 10.1016/j.surg.2010.12.002. View