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Risk factors and consequences of conversion to open surgery in laparoscopic common bile duct exploration

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Abstract

Background

Although laparoscopic common bile duct exploration (LCBDE) has shown many obvious advantages compared with open surgery in the treatment of common bile duct (CBD) stones, it remains unclear regarding risk factors of conversion from LCBDE to open surgery and whether conversion will counteract the advantages of LCBDE. The purpose of this study was to explore risk factors and consequences of conversion from LCBDE to open surgery.

Methods

A retrospective study was conducted, using a database of 644 patients with LCBDE between 2011 and 2017. Risk factors for conversion to open surgery were determined based on univariable and multivariable analysis. The consequences of conversion to open surgery in LCBDE were analyzed.

Results

Conversion was required in 27 (4.2%) of 644 patients undergoing LCBDE. Independent risk factors for conversion were as follows: the max diameter of stones in CBD (odds ratio (OR) 2.234, 95%CI 1.031–4.842; p = 0.042), edema of CBD (OR 12.530, 95%CI 4.633–33.887; p < 0.001), and multiple stones in CBD (OR 3.438, 95%CI: 1.133–10.428; p = 0.029). These risk factors and their combined were good predictors for conversion in LCBDE. More blood loss, longer operative time, longer postoperative hospital stay, and higher incision infection were identified in patients with conversion than those without conversion. However, no significant differences were observed regarding mortality, readmission within 30 days, reoperation, bile leakage, and intra-abdominal fluid collection.

Conclusion

Conversion to open surgery in LCBDE was associated with acute edematous CBD with large and multiple stones. Conversion can offset the advantages of LCBDE.

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Abbreviations

LCBDE:

Laparoscopic common bile duct exploration

LCBDE-PC:

Laparoscopic common bile duct exploration with primary closure

LTCBDE:

Laparoscopic transcystic common bile duct exploration

LC:

Laparoscopic cholecystectomy

PC:

Primary closure

PS:

Propensity score

ERCP:

Endoscopic retrograde cholangiopancreatography

EST:

Endoscopic sphincterotomy

CI:

Confidence interval

OR:

Odds ratio

MD:

Mean difference

CBD:

Common bile duct

ROC:

Receiver operating characteristic

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Acknowledgements

This work was supported by the Scientific Research Foundation for the Returned Overseas Chinese Scholars, Chinese Ministry of Education, Shanghai Tenth Hospital’s improvement plan for NSFC (SYGZRPY2017004), and Natural Science Foundation of Shanghai (18ZR1429600).

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Authors and Affiliations

  1. Department of General Surgery, Shanghai 10th People’s Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, People’s Republic of China

    Bin Xu, Yu-Xiang Wang, Yong-Xin Qiu, Hong-Bo Meng, Jian Gong, Wei Sun, Bo Zhou, Jian He, Ti Zhang & Zhen-Shun Song

  2. Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200232, People’s Republic of China

    Wen-Yan Zheng

Authors
  1. Bin Xu
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  2. Yu-Xiang Wang
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  6. Wei Sun
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  7. Bo Zhou
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  10. Wen-Yan Zheng
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  11. Zhen-Shun Song
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Contributions

BX, Y-XW, and Y-XQ contributed equally to this work; XB, WZ, and Z-SS designed the research; BX, Y-XW, Y-XQ, H-BM, JG, WS, BZ, JH, TZ, Z-SS performed the research; BX, Y-XW, Y-XQ, and WZ collected and analyzed the data; BX, Y-XW, Z-SS, and Y-XQ wrote the paper.

Corresponding authors

Correspondence to Wen-Yan Zheng or Zhen-Shun Song.

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Disclosures

Bin Xu, Yu-Xiang Wang, Yong-Xin Qiu, Hong-Bo Meng, Jian Gong, Wei sun, Bo Zhou, Jian He, Ti Zhang, Wen-Yan Zheng, and Zhen-Shun Song have no conflict of interests or financial ties to disclose.

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Xu, B., Wang, YX., Qiu, YX. et al. Risk factors and consequences of conversion to open surgery in laparoscopic common bile duct exploration. Surg Endosc 32, 4990–4998 (2018). https://doi.org/10.1007/s00464-018-6263-4

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  • DOI: https://doi.org/10.1007/s00464-018-6263-4

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