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Laparoscopic common bile duct exploration in patients with previous upper abdominal surgery

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Abstract

Background

Although patients with previous upper abdominal surgery are no longer considered as a contraindication in laparoscopic surgery, laparoscopic common bile duct exploration (LCBDE) for these patients is still controversial. The aim of this study was to evaluate the safety and effectiveness of LCBDE for patients with previous upper abdominal surgery.

Methods

Two hundred and seventeen patients with common bile duct stones who underwent LCBDE in our institution from January 2010 to September 2017 were enrolled in the retrospective study. They were divided into two groups: group A, with previous upper abdominal surgery (n = 50) and group B, without previous upper abdominal surgery (n = 167). Patients’ demographic, intraoperative, and postoperative outcomes were retrospectively analyzed.

Results

Group A exhibited a longer operative time compared to group B (179.7 ± 61.5 vs. 156.0 ± 46.8 min, p = 0.014). There was no significant difference in intraoperative blood loss (123.9 ± 99.5 vs. 99.5 ± 84.7 mL, p = 0.087), postoperative hospital stay (7.4 ± 2.6 vs. 6.8 ± 2.3 d, p = 0.193), and overall complication rate (8.0 vs. 5.4%, p = 0.732) between the two groups. There was no mortality in both groups. The initial stone clearance rate showed no significant difference between the two groups (98.0 vs. 98.2%, p = 1.000), and the final stone clearance rate was 100% in both groups (p = 1.000). The stone recurrence rate had no significant difference between the two groups (2.0 vs. 2.4%, p = 1.000). The conversion rate was comparable between group A and group B (6.0 vs. 4.8%, p = 0.718).

Conclusions

LCBDE is a safe and feasible procedure for patients with previous upper abdominal surgery. The keys of this procedure are carefully separating the adhesions and clearly exposing the common bile duct, and using a variety of methods to remove the stones.

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Author notes

  1. Jisheng Zhu and Gen Sun have contributed equally to this work, and both should be considered as first author.

Authors and Affiliations

  1. Department of General Surgery, The First Affiliated Hospital of Nanchang University, No. 17 Yongwai Zhengjie, Nanchang, 330006, Jiangxi, China

    Jisheng Zhu, Gen Sun, Le Hong, Xiaohua Li, Yong Li & Weidong Xiao

Authors
  1. Jisheng Zhu
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  2. Gen Sun
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  3. Le Hong
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  4. Xiaohua Li
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  5. Yong Li
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  6. Weidong Xiao
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Corresponding author

Correspondence to Weidong Xiao.

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Disclosures

Drs. Jisheng Zhu, Gen Sun, Le Hong, Xiaohua Li, Yong Li, and Weidong Xiao have no conflicts of interest or financial ties to disclose.

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Zhu, J., Sun, G., Hong, L. et al. Laparoscopic common bile duct exploration in patients with previous upper abdominal surgery. Surg Endosc 32, 4893–4899 (2018). https://doi.org/10.1007/s00464-018-6248-3

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  • DOI: https://doi.org/10.1007/s00464-018-6248-3

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