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Primary closure after laparoscopic common bile duct exploration is safe and feasible for patients with non-severe acute cholangitis

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Abstract

Background

The safety and feasibility of primary closure after laparoscopic common bile duct exploration (LCBDE) have been confirmed in elective settings. However, the suitability of primary closure after LCBDE in the treatment of patients with non-severe acute cholangitis in emergency settings remains unclear. The aim of the present study was to explore the safety and feasibility of LCBDE with primary closure in patients with non-severe acute cholangitis.

Methods

Consecutive patients with choledocholithiasis combined with gallbladder stones treated by LCBDE with primary closure at our institution from January 2015 to April 2021 were retrospectively reviewed. These patients were divided into two groups: emergency group (patients with non-severe acute cholangitis) and elective group (patients without acute cholangitis). The demographic and perioperative data of the two groups were compared.

Results

One hundred twenty-two patients received LCBDE combined with primary closure during this period, including 70 in the emergency group and 52 in the elective group. Baseline characteristics were balanced in both groups, except for higher levels of white blood cells (WBC), C-reactive protein (CRP), total bilirubin, alkaline phosphatase (ALP), and albumin in the emergency group. No postoperative mortality occurred in either group. Compared to the elective group, the emergency group had a longer operation time (P = 0.011), and more estimated blood loss (P < 0.001). No significant differences were found between the two groups in terms of conversion (2.9% vs. 0.0%, P = 0.507), use of baskets (84.2% vs. 78.8%, P = 0.481), use of electrohydraulic lithotripsy (EHL) (2.9% vs. 1.9%, P = 1.000), or postoperative hospital stay (P = 0.214). The incidence of postoperative complications was comparable between the two groups. During the follow-up period, none of the patients experienced biliary stricture, and 1 case of stone recurrence occurred in the elective group.

Conclusions

LCBDE with primary closure for choledocholithiasis patients with non-severe acute cholangitis has the equivalent efficacy and morbidity to elective surgery. Primary closure after LCBDE is a safe and feasible option for choledocholithiasis patients with non-severe acute cholangitis.

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Abbreviations

LCBDE:

Laparoscopic common bile duct exploration

ERCP:

Endoscopic retrograde cholangiopancreatography

CBD:

Common bile duct

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Authors and Affiliations

  1. Department of General Surgery, Hefei Second People’s Hospital, Anhui Medical University, Hefei, 230011, Anhui Province, People’s Republic of China

    You Jiang, Jun Lu, Wenbo Li, Jun Zhang & Liang Li

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Correspondence to Liang Li.

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Our local Institutional Review Board (The ethics committee of Hefei Second People’s Hospital) reviewed and approved this research. In view of the retrospective nature of the study, and as all the procedures performed were part of the routine care, no informed consent was required.

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The authors declare no competing interests.

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You Jiang and Jun Lu contributed equally to this work and should be considered co-first authors.

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Jiang, Y., Lu, J., Li, W. et al. Primary closure after laparoscopic common bile duct exploration is safe and feasible for patients with non-severe acute cholangitis. Langenbecks Arch Surg 407, 1553–1560 (2022). https://doi.org/10.1007/s00423-022-02547-z

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