Korean J Hepatobiliary Pancreat Surg.  2012 Nov;16(4):154-159. 10.14701/kjhbps.2012.16.4.154.

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

• Yun KW
• Ahn YJ
• Lee HW
• Jung IM
• Chung JK
• Heo SC
• Hwang KT
• Ahn HS

• KMID: 2243194
• DOI: http://doi.org/10.14701/kjhbps.2012.16.4.154

Abstract

BACKGROUNDS/AIMS
We aimed to to evaluate the feasibility of laparoscopic common bile duct exploration (LCBDE) in patients with previous upper abdominal surgery.
METHODS
Retrospective analysis was performed on data from the attempted laparoscopic common bile duct exploration in 44 patients. Among them, 5 patients with previous lower abdominal operation were excluded. 39 patients were divided into two groups according to presence of previous upper abdominal operation; Group A: patients without history of abdominal operation. (n=27), Group B: patients with history of upper abdominal operation. Both groups (n=12) were compared to each other, with respect to clinical characteristics, operation time, postoperative hospital stay, open conversion rate, postoperative complication, duct clearance and mortality.
RESULTS
All of the 39 patients received laparoscopic common bile duct exploration and choledochotomy with T-tube drainage (n=38 [97.4%]) or with primary closure (n=1). These two groups were not statistically different in gender, mean age and presence of co-morbidity, mean operation time (164.5+/-63.1 min in group A and 134.8+/-45.2 min in group B, p=0.18) and postoperative hospital stay (12.6+/-5.7 days in group A and 9.8+/-2.9 days in group B, p=0.158). Duct clearance and complication rates were comparable (p>0.05). 4 cases were converted to open in group A and 1 case in group B respectively. In group A (4 of 27 (14.8%) and 1 of 12 (8.3%) in group B, p=0.312) Trocar or Veress needle related complication did not occur in either group.
CONCLUSIONS
LCBDE appears to be a safe and effective treatment even in the patients with previous upper abdominal operation if performed by experienced laparoscopic surgeon, and it can be the best alternative to failed endoscopic retrograde cholangiopancreatography for difficult cholelithiasis.

Keyword

Laparoscopic common bile duct exploration; Previous surgery

MeSH Terms

Cholangiopancreatography, Endoscopic Retrograde
Cholelithiasis
Common Bile Duct
Drainage
Humans
Length of Stay
Needles
Postoperative Complications
Retrospective Studies
Surgical Instruments

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