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Laparoscopic common bile duct exploration with primary closure is beneficial for patients with previous upper abdominal surgery

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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.

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Abbreviations

CBD:

Common bile duct

LCBDE:

Laparoscopic common bile duct exploration

PC:

Primary closure

LCBDE-PC:

Laparoscopic common bile duct exploration with primary closure

LCBDE-T:

Laparoscopic common bile duct exploration with T tube drainage

LC:

Laparoscopic cholecystectomy

OCBDE:

Open common bile duct exploration

OCBDE-PC:

Open common bile duct exploration with primary closure

OCBDE-T:

Open common bile duct exploration with T tube drainage

PS:

Propensity score

PUAS:

Previous upper abdominal surgery

PLAS:

Previous lower abdominal surgery

ERCP:

Endoscopic retrograde cholangiopancreatography

EST:

Endoscopic sphincterotomy

CI:

Confidence interval

OR:

Odds ratio

MD:

Mean difference

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Acknowledgements

This work was supported by Natural Science Foundation of Shanghai (18ZR1429600).

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Author notes

  1. Bin Xu, Tingyi Luo, Tingsong Yang have contributed equally to this work.

Authors and Affiliations

  1. Department of General Surgery, Shanghai 10th People’s Hospital, Tongji University School of Medicine, Shanghai, 200072, China

    Bin Xu, Tingyi Luo, Tingsong Yang, Shilin Wang, Hongbo Meng, Jian Gong, Bo Zhou & Zhenshun Song

  2. Department of Surgical Intensive Care Unit, Zhong Shan Hospital, Fudan University, Shanghai, 200232, China

    Wenyan Zheng

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  1. Bin Xu
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Bin Xu, Tingyi Luo, Tingsong Yang, Shilin Wang, Hongbo Meng, Jian Gong, Bo Zhou, Wenyan Zheng, and Zhenshun Song have no conflicts of interest to disclose.

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Xu, B., Luo, T., Yang, T. et al. Laparoscopic common bile duct exploration with primary closure is beneficial for patients with previous upper abdominal surgery. Surg Endosc 36, 1053–1063 (2022). https://doi.org/10.1007/s00464-021-08371-8

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