Shadi Aboudi1, Samer Kawak2, Katherine Su3, Tyrone Rogers3, Eugene E Ceppa3. 1St. Vincent Medical Group, Indiana University Health, 2Beaumont Health, 3Indiana University school of medicine
Introduction: Although minimally invasive surgery is a well-recognized part of modern surgery, the adoption of complex minimally invasive biliary procedures (MIBP) is unknown.
Methods: A comprehensive literature search of MIBP from 2011-2016 was performed by querying multiple electronic databases regardless of language of origin. All diagnoses and procedures relating primary to the biliary system were included. Laparoscopic cholecystectomy and related procedures were excluded from the search due to its universal application. Postoperative outcomes were assessed. Historical controls for open complex biliary procedures were used for comparison. P value < 0.05 was defined as statistically significant.
Results: A total of 16 studies from 2011 to 2016 were included in this review; multiple other studies were excluded for lacking sufficient details. A total of 352 patients underwent complex MIBP. Three minimally invasive modalities were distinguished including laparoscopic assisted (n=12), laparoscopic (n=329), and robotic (n=11). Various surgical techniques were used including Roux-en-Y (REY) hepaticojejunostomy (n=132), hepaticojejunostomy (n=116), primary anastomosis + T-tube (n=94), choledochoduodenostomy (n=7), and REY cholangiojejunostomy (n=3). Observed major morbidity (20% vs. 17%), biliary fistula (6% vs. 3%), anastomotic stricture (1.2% vs. 2%), reoperation rate (2% vs. 2%), and mortality (0.6% vs. <1%) after MIBP and open procedures respectively; no postoperative occurrence was statistically distinct. Mean operative times were found to be significantly longer in MIBP (385 minutes vs. 256 minutes), yet each study found operative times decreased in the MIBP with increased surgeon experience. Length of stay was significantly less in the MIBP compared to open procedures (5.8 days vs. 8 days).
Conclusion: Very few reports and a paucity of data exist documenting outcomes from complex MIBP. The limited data suggest that complex MIBP can be performed safely and effectively, yet universal adoption is not apparent based on the total number of patients in the literature. Further series are needed to more accurately compare outcomes.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87489
Program Number: P113
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster