Journal List > Korean J Hepatobiliary Pancreat Surg > v.16(4) > 1040558

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Yun, Ahn, Lee, Jung, Chung, Heo, Hwang, and Ahn: Laparoscopic common bile duct exploration in patients with previous upper abdominal operations
Original Article
Korean Journal of Hepato-Biliary-Pancreatic Surgery

Korean Journal of Hepato-Biliary-Pancreatic Surgery 2012; 16(4): 154-159.

Published online: 30 November 2012

DOI: https://doi.org/10.0000/kjhbps.2012.16.4.154

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

Keong Won Yun1, 2, Young Joon Ahn1, Hae Won Lee1, In Mok Jung1, Jung Kee Chung1, Seung Chul Heo1, Ki-Tae Hwang1, Hye Seong Ahn1

1Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea.

2Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.

Corresponding author: Young Joon Ahn. Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 20, Boramae 5-gil, Dongjak-gu, Seoul 156-707, Korea. Tel: +82-2-870-2274, Fax: +82-2-870-3863, ahnyj@brm.co.kr

Received 12 October 2012       Revised 15 October 2012       Accepted 16 October 2012

Copyright © 2012 Korean Association of HBP Surgery

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.

Keywords: Laparoscopic common bile duct exploration, Previous surgery

Figures and Tables

Table 1
Indications of laparoscopic common bile duct exploration
kjhbps-16-154-i001
Table 2
Types of previous abdominal operations in group B
kjhbps-16-154-i002

Group B, presence of upper abdominal operation

*Not included in this study

Table 3
Characteristics of patients in both groups
kjhbps-16-154-i003

Group A, absence of previous abdominal operation; Group B, presence of upper abdominal operation; AST, aspartate transaminase; ALT, alanine transaminase; CBD, common bile duct; CT, computed tomography

Table 4
Comparison of operative results in both groups
kjhbps-16-154-i004

Group A, absence of previous abdominal operation; Group B, presence of upper abdominal operation

Table 5
Postoperative complications
kjhbps-16-154-i005

Group A, absence of previous abdominal operation; Group B, presence of upper abdominal operation

*A case of open conversion

References

1. Beal JM. Historical perspective of gallstone disease. Surg Gynecol Obstet. 1984. 158:181–189.
2. Soper NJ. Laparoscopic general surgery--past, present, and future. Surgery. 1993. 113:1–3.
3. Crawford DL, Phillips EH. Laparoscopic common bile duct exploration. World J Surg. 1999. 23:343–349.
4. Vandervoort J, Soetikno RM, Tham TC, et al. Risk factors for complications after performance of ERCP. Gastrointest Endosc. 2002. 56:652–656.
5. Poulose BK, Arbogast PG, Holzman MD. National analysis of in-hospital resource utilization in choledocholithiasis management using propensity scores. Surg Endosc. 2006. 20:186–190.
6. Franklin ME Jr, Pharand D, Rosenthal D. Laparoscopic common bile duct exploration. Surg Laparosc Endosc. 1994. 4:119–124.
7. Lezoche E, Paganini AM. Single-stage laparoscopic treatment of gallstones and common bile duct stones in 120 unselected, consecutive patients. Surg Endosc. 1995. 9:1070–1075.
8. Millat B, Fingerhut A, Deleuze A, et al. Prospective evaluation in 121 consecutive unselected patients undergoing laparoscopic treatment of choledocholithiasis. Br J Surg. 1995. 82:1266–1269.
9. Rhodes M, Nathanson L, O'Rourke N, et al. Laparoscopic exploration of the common bile duct: lessons learned from 129 consecutive cases. Br J Surg. 1995. 82:666–668.
10. Urbach DR, Khajanchee YS, Jobe BA, et al. Cost-effective management of common bile duct stones: a decision analysis of the use of endoscopic retrograde cholangiopancreatography (ERCP), intraoperative cholangiography, and laparoscopic bile duct exploration. Surg Endosc. 2001. 15:4–13.
11. Rhodes M, Sussman L, Cohen L, et al. Randomised trial of laparoscopic exploration of common bile duct versus postoperative endoscopic retrograde cholangiography for common bile duct stones. Lancet. 1998. 351:159–161.
12. Karayiannakis AJ, Polychronidis A, Perente S, et al. Laparoscopic cholecystectomy in patients with previous upper or lower abdominal surgery. Surg Endosc. 2004. 18:97–101.
13. Parsons JK, Jarrett TJ, Chow GK, et al. The effect of previous abdominal surgery on urological laparoscopy. J Urol. 2002. 168:2387–2390.
14. Schirmer BD, Dix J, Schmieg RE Jr, et al. The impact of previous abdominal surgery on outcome following laparoscopic cholecystectomy. Surg Endosc. 1995. 9:1085–1089.
15. Yu SC, Chen SC, Wang SM, et al. Is previous abdominal surgery a contraindication to laparoscopic cholecystectomy? J Laparoendosc Surg. 1994. 4:31–35.
16. Law WL, Lee YM, Chu KW. Previous abdominal operations do not affect the outcomes of laparoscopic colorectal surgery. Surg Endosc. 2005. 19:326–330.
17. Tai CK, Tang CN, Ha JP, et al. Laparoscopic exploration of common bile duct in difficult choledocholithiasis. Surg Endosc. 2004. 18:910–914.
18. Shin HS, Chun KS, Song IS. Laparoscopic common bile duct exploration in patients with failed endoscopic stone extraction. Korean J Hepatobiliary Pancreat Surg. 2009. 13:164–170.
19. Park YC, Jeong JS, Jeong JG, et al. The clinical outcome of laparoscopic common bile duct exploration for the primary treatment of choledocholithiasis. Korean J Hepatobiliary Pancreat Surg. 2011. 15:13–18.
20. Li LB, Cai XJ, Mou YP, et al. Reoperation of biliary tract by laparoscopy: experiences with 39 cases. World J Gastroenterol. 2008. 14:3081–3084.
21. Tang CN, Tsui KK, Yang GP, et al. Laparoscopic exploration of common bile duct in post-gastrectomy patients. Hepatogastroenterology. 2008. 55:846–849.
22. Zinther NB, Zeuten A, Marinovskij E, et al. Detection of abdominal wall adhesions using visceral slide. Surg Endosc. 2010. 24:3161–3166.
23. Hanney RM, Carmalt HL, Merrett N, et al. Vascular injuries during laparoscopy associated with the Hasson technique. J Am Coll Surg. 1999. 188:337–338.
24. Dunne N, Booth MI, Dehn TC. Establishing pneumoperitoneum: Verres or Hasson? The debate continues. Ann R Coll Surg Engl. 2011. 93:22–24.
25. Chung HJ, Park IY. Ultrasound can prevent visceral injuries during the creation of pneumoperitoneum in patients with previous abdominal surgery. J Korean Soc Endosc Laparosc Surg. 2006. 9:45–48.
26. Wu JS, Soper NJ. Comparison of laparoscopic choledochotomy closure techniques. Surg Endosc. 2002. 16:1309–1313.
27. El-Geidie AA. Is the use of T-tube necessary after laparoscopic choledochotomy? J Gastrointest Surg. 2010. 14:844–848.
28. Zhang WJ, Xu GF, Wu GZ, et al. Laparoscopic exploration of common bile duct with primary closure versus T-tube drainage: a randomized clinical trial. J Surg Res. 2009. 157:e1–e5.
29. Chen CC, Wu SD, Tian Y, et al. Sphincter of Oddi-preserving and T-tube-free laparoscopic management of extrahepatic bile duct calculi. World J Surg. 2011. 35:2283–2289.
30. Jameel M, Darmas B, Baker AL. Trend towards primary closure following laparoscopic exploration of the common bile duct. Ann R Coll Surg Engl. 2008. 90:29–35.
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