The Clinical Effect Of Laparoscopic Common Bile Duct Exploration In Patients With Or Without Previous Upper Abdominal Surgery

Objective: To investigate the safety and clinical effect of laparoscopic common bile duct exploration for patients with previous upper abdominal surgery.Methods: The clinical data of patients with common bile duct stones who underwent LCBDE in our institution from January 2010 to November 2018 were retrospectively analyzed.According to whether they had a history of upper abdominal surgery,they were divided into two groups: group A,with previous upper abdominal surgery(n=74)and group B,without previous upper abdominal surgery(n=253).The differences of conversion rate,stone clearance rate,operation time,intraoperative blood loss,postoperative hospital stay,postoperative complications and stone recurrence rate between the two groups were compared and analyzed.Results: In group A,4 cases were converted to laparotomy,and the success rate of laparoscopic surgery was 94.6%.In group B,11 cases were converted to laparotomy,and the success rate of laparoscopic surgery was 95.7%.There was no significant difference between the two groups(P=0.752).Group A exhibited a longer operative time compared to group B(168.1±59.0 vs 151.0±49.0 min,P=0.012),but there were no significant difference in intraoperative blood loss(120.2±92.0 vs 106.1±87.6 ml,P=0.244),and postoperative hospital stay(7.3±2.7 vs 6.7±2.6 d,P=0.127)between the two groups.Five patients had postoperative complications in group A,including three bile leakage and two gastroduodenal serosal injury,and fourteen patients had postoperative complications in group B,including ten bile leakage,two intra-abdominal infection,and one intra-abdominal bleeding,and one incision infection.There was no significant difference in overall complication rate(6.8% vs 5.5%,P=0.777)and biliary leakage rate(4.1% vs 4.0%,P=1.000)between the two groups.There was no reoperation and mortality in both groups.The initial stone clearance rate showed no significant difference between the two groups(97.3% vs 98.0%,P=0.659),and the final stone clearance rate was 100% in both groups(P=1.000).There was two patients with recurrent stones in group A and six in group B,and no significant difference in stone recurrence rate was seen(2.7% vs 2.4%,P=1.000).Conclusion: Laparoscopic common bile duct exploration is not a contraindication in patients with previous upper abdominal surgery,but it is more difficult.LCBDE is a safe and feasible procedure for patients with previous upper abdominal surgery.The keys of this procedure are carefully separating the adhesions and clearly exposing the common bile duct,and using a variety of methods to remove the stones.