Yoshihide Chino, PhD, Masaki Fujimura, PhD, Isao Sato, MD, Hajime Yamazaki, PhD, Makoto Mizutani, PhD, Tomatake Tabata, MD, Iwao Kitazono, MD. Daiichi-Towakai-Hospital endoscopic surgery center.
In Japan, common bile duct stones (CBDS) were first treated with endoscopic sphincterotomy (EST), and then with laparoscopic cholecystectomy Recently however, the advent of laparoscopic procedures has led to an increasingly important role for laparoscopic common bile duct exploration in the treatment of CBDS. . At this meeting in 2011, we reported on the safety of LCBDE using C-tube. The aim of the current study was to evaluate the efficacy and safety of LCBDE for patients who have had previous operations.
Between 2004 and 2012, 303 patients underwent LCBDE in our hospital. Postoperative bile drainage was carried out via C-tube, endoscopic nasobiliary drainage (ENBD), or endoscopic retrograde biliary drainage (ERBD). 70 patients with previous operations (groupA) were retrospectively reviewed. The points evaluated were: operation time, blood loss, post operative day of C-tube removal, length of hospital stays, CBD stone clearance rate, morbidity and mortality. These were statistically compared with another 233 patients (group B).
There were 45 male patients and 25 female patients in group A, and 114 males and 119 females in group B. Their mean age was 70±12 years in group A, and 69±13 in group B. Previous operations included open gastrectomy (17), appendectomy (17), gynecologic surgery (16), cholecystectomy (10), colorectal surgery (7), inguinal hernia (2), and others (8). CBD stones were cleared with choledochotomy (88%) or transcystic exploration (12%). Mean operation times, blood loss, postoperative C-tube removal times and hospital stays in groups A and B were 201±61min and 197±59 min, 15±29 and 19±43ml, 4.8±2.2 days and 5.0±2.7 days, 8.5±8.6 days and 10.0±8.8 days, respectively. There were no significant statistical differences between the two groups. The CBD clearance rate was 99% in group A and 98% in group B. Morbidities included pancreatitis (1.4%) in groupA, and bile leakage (0.4%) in groupB. There was no mortality in group A, but two patients (0.8%) in group B died, one of acute myocardial infarction and another of hematemesis.
Experience in our institute has shown LCBDE to be a safe and feasible procedure for patients who have had previous operations.