Abstract
Background
Laparoscopic common bile duct exploration (LCBDE) has been widely promoted in recent years as a safe and effective treatment for choledocholithiasis. However, there are no standard guidelines for the treatment of patients who have concomitant hepatolithiasis of the left liver and abdominal adhesions. The aim of the current research was to compare the outcomes of open versus laparoscopic common bile duct exploration with left hepatectomy (OCBDH vs. LCBDH) in patients with choledocholithiasis concomitant with left-sided hepatolithiasis, and to evaluate the safety and feasibility of laparoscopic surgery for choledocholithiasis in patients with abdominal adhesions.
Methods
Between October 2012 and October 2015, a total of 321 consecutive patients with choledocholithiasis underwent surgical treatment. LCBDE was performed in 107 patients, and open common bile duct exploration (OCBDE) was performed in 111 patients. Further, 31 patients and 72 patients underwent LCBDH and OCBDH, respectively. A total of 133 patients who underwent LCBDE or OCBDE had abdominal adhesions, which were classified as mild, moderate, or severe according to an abdominal adhesion scoring system, which was validated in the LCBDE group and OCBDE group. The perioperative results were reviewed and analyzed retrospectively.
Results
In the mild adhesion group, blood loss, postoperative recovery in the LCBDE group was lesser than those in the OCBDE group. In the moderate adhesion group, the postoperative recovery was significantly shorter in the LCBDE group than in the OCBDE group. In the severe adhesion group, the operation time and blood loss in the LCBDE group were higher than those in the OCBDE group. The postoperative recovery was significantly better in the LCBDH group than in the OCBDH group.
Conclusion
LCBDH can obviously improve recovery and shorten the hospitalization period. Further, LCBDE is safe and feasible for patients of choledocholithiasis with mild and moderate abdominal adhesions.
Similar content being viewed by others
References
Grubnik VV et al (2012) Laparoscopic common bile duct exploration versus open surgery: comparative prospective randomized trial. Surg Endosc 26(8):2165–2171
Lee A et al (2011) Laparoscopic common bile duct exploration for elderly patients: as a first treatment strategy for common bile duct stones. J Korean Surg Soc 81(2):128–133
Magalhaes J, Rosa B, Cotter J (2015) Endoscopic retrograde cholangiopancreatography for suspected choledocholithiasis: from guidelines to clinical practice. World J Gastrointest Endosc 7(2):128–134
Hong WD, Zhu QH, Huang QK (2011) Endoscopic sphincterotomy plus endoprostheses in the treatment of large or multiple common bile duct stones. Dig Endosc 23(3):240–243
Lv S et al (2015) One-step LC and ERCP treatment of 40 Cases with cholelithiasis complicated with common bile duct stones. Hepatogastroenterology 62(139):570–572
Lu Y et al (2016) Is ERCP both effective and safe for common bile duct stones removal in octogenarians? A comparative study. Aging Clin Exp Res 28(4):647–652
Baucom RB et al (2016) Surgeons, ERCP, and laparoscopic common bile duct exploration: do we need a standard approach for common bile duct stones? Surg Endosc 30(2):414–423
Aawsaj Y, Light D, Horgan L (2016) Laparoscopic common bile duct exploration: 15-year experience in a district general hospital. Surg Endosc 30(6):2563–2566
Ye X et al (2015) Laparoscopic versus open left hemihepatectomy for hepatolithiasis. J Surg Res 199(2):402–406
Namgoong JM et al (2014) Comparison of laparoscopic versus open left hemihepatectomy for left-sided hepatolithiasis. Int J Med Sci 11(2):127–133
Hull TL et al (2012) Adhesions after laparoscopic and open ileal pouch-anal anastomosis surgery for ulcerative colitis. Br J Surg 99(2):270–275
Dowson HM et al (2008) Reduced adhesion formation following laparoscopic versus open colorectal surgery. Br J Surg 95(7):909–914
Tan J et al (2015) Endoscopic or laparoscopic approach for hepatolithiasis in the era of endoscopy in China. Surg Endosc 29(1):154–162
Yachimski P, Poulose BK (2010) ERCP vs laparoscopic common bile duct exploration for common bile duct stones: are the 2 techniques truly equivalent? Arch Surg 145(8):795; author reply 795–6
Elgeidie A, Atif E, Elebidy G (2017) Intraoperative ERCP for management of cholecystocholedocholithiasis. Surg Endosc 31(2):809–816
Masci E et al (2001) Complications of diagnostic and therapeutic ERCP: a prospective multicenter study. Am J Gastroenterol 96(2):417–423
Poh BR et al (2016) Randomized clinical trial of intraoperative endoscopic retrograde cholangiopancreatography versus laparoscopic bile duct exploration in patients with choledocholithiasis. Br J Surg 103(9):1117–1124
Poulose BK, Arbogast PG, Holzman MD (2006) National analysis of in-hospital resource utilization in choledocholithiasis management using propensity scores. Surg Endosc 20(2):186–190
Vindal A et al (2015) Comparison between intraoperative cholangiography and choledochoscopy for ductal clearance in laparoscopic CBD exploration: a prospective randomized study. Surg Endosc 29(5):1030–1038
Hongjun H, Yong J, Baoqiang W (2015) Laparoscopic common bile duct exploration: choledochotomy versus transcystic approach? Surg Laparosc Endosc Percutaneous Tech 25(3):218–222
Dong ZT et al (2014) Primary closure after laparoscopic common bile duct exploration versus T-tube. J Surg Res 189(2):249–254
Hua J et al (2015) Primary closure and rate of bile leak following laparoscopic common bile duct exploration via choledochotomy. Dig Surg 32(1):1–8
Cai H et al (2012) Primary closure following laparoscopic common bile duct exploration combined with intraoperative cholangiography and choledochoscopy. World J Surg 36(1):164–170
Hongjun H, Yong J, Baoqiang W (2015) Laparoscopic common bile duct exploration: choledochotomy versus transcystic approach? Surg Laparosc Endosc Percutaneous Tech 25(3):218–222
Hsu WC et al (2006) Visceral sliding technique is useful for detecting abdominal adhesion and preventing laparoscopic surgical complications. Gynecol Obstet Investig 62(2):75–78
Yajima H et al (2014) Reasons and risk factors for intraoperative conversion from laparoscopic to open cholecystectomy. Surg Today 44(1):80–83
Hackenberg T et al (2017) Laparoscopic versus open surgery for acute adhesive small-bowel obstruction: a propensity score-matched analysis. Scand J Surg 106(1):28–33
Zhou F et al (2013) Laparoscopic hepatectomy is associated with a higher incident frequency in hepatolithiasis patients. Surg Today 43(12):1371–1381
Shin YC et al (2016) Comparison of laparoscopic versus open left-sided hepatectomy for intrahepatic duct stones. Surg Endosc 30(1):259–265
Tian J et al (2013) Laparoscopic hepatectomy with bile duct exploration for the treatment of hepatolithiasis: an experience of 116 cases. Dig Liver Dis 45(6):493–498
Cai X et al (2014) Laparoscopic liver resection and the learning curve: a 14-year, single-center experience. Surg Endosc 28(4):1334–1341
Acknowledgments
This study was supported by grants from the National Natural Science Foundation of China (no. 81502004, and no. 81272728) and the Foundation of Shanghai Science and Technology Committee (16411952000, 11JC1416202, 10411955500).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
Dr. Yueqi Wang, Dr. Xiaobo Bo, Dr. Yaojie Wang, Dr. Min Li, Dr. Sheng Shen, Dr. Tao Suo, Dr. Hongtao Pan, Dr. Han Liu, and Dr. Houbao Liu have no conflicts of interest or finical ties to disclosure.
Rights and permissions
About this article
Cite this article
Wang, Y., Bo, X., Wang, Y. et al. Laparoscopic surgery for choledocholithiasis concomitant with calculus of the left intrahepatic duct or abdominal adhesions. Surg Endosc 31, 4780–4789 (2017). https://doi.org/10.1007/s00464-017-5555-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-017-5555-4