The Experience Of Laparoscopic Cholecystectomy And Common Bile Duct Lithotomy In Patients With Previous Gastrectomy

Objective: Laparoscopic Cholecystectomy(LC) and Common Bile Duct Lithotomy(LCBDL) in Patients with Previous Gastrectomy,We aimed to evaluate the feasibility and technique of the surgery.Methods: We retrospectively assessed the data of 30 patients who had undergone gastrectomy from Department of Hepatobiliary Surgery of First Affiliated Hospital of Fujian Medical University between March 1, 2010 and January 31, 2016. all patients were treated with LC and LCBDL, including the patient’s age, sex, underlying disease, inflammation, the history of gastrectomy, Preoperative diagnosis were concomitant common bile duct stones and gallstones or other benign diseases.all patients were treated with the method of creating pneumoperitioncum openly, then them received the LC(except for gallbladder resected)+LCBDL+Abdominal adhesions dissection+Intraoperative fibercholedochoscopy+T tube drainage or primary suture, conversion in laparoscopic surgery when it was difficult to complete.Results: Among them,29 patients were completed successfully, including 24 patients who undergone LC + LCBDL(17 T tube drainage, 7 primary suture). 5 patients who undergone LCBDL(3 T tube drainage, 2 primary suture). however,1 patient was converted to laparotomy(T tube drainage) because of tight adhesion of calot triangle and the tisses surrounding common bile duct, the open conversion rate was 3.3%(1/30), the common bile duct diameter was about 11 mm,1 patient had intraoperative blood much,who was treated with transfusion, no serious postoperative complications happened. There was 1 patient appeared postoperative biliary and abdominal incision infections, who was accepted by the active treatment, and the remain patients had no intraoperative and postoperative bleeding, biliary leakage, infection or other complications. All of the 30 patients were discharged securely.follow-up(range 4 months to 72 months):24 patients were no residual stone or cholangitis(2 patients have died),2 patients stone recurred,3 patients were lost to follow-up,.Conclusions: It had been proven not security but also feasible that the LC and LCBDL for the patients who were diagnosed concomitant common bile duct stones and gallstones or other benign diseases in patients with gastrectomy, the surgeon should review the history of gastrectomy to evaluate the abdominal adhesions. Selecting the initial trocar and creating pneumoperitoneum are very important for the operation.