Yang QS, Zhang M, Ma CS, Teng D, Li A, Dong JD, Wang XF, Liu FB. Analysis of risk factors for bile leakage after laparoscopic exploration and primary suture of common bile duct. World J Gastrointest Surg 2025; 17(3): 102190 [DOI: 10.4240/wjgs.v17.i3.102190]
Corresponding Author of This Article
Fu-Bao Liu, Chief Physician, PhD, Department of Hepatobiliary and Pancreatic Surgery, General Surgery, The First Affiliated Hospital of Anhui Medical University, No. 120 Wanshui Road, Nanqiao District, Hefei 230022, Anhui Province, China. 18955015210@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Mar 27, 2025; 17(3): 102190 Published online Mar 27, 2025. doi: 10.4240/wjgs.v17.i3.102190
Analysis of risk factors for bile leakage after laparoscopic exploration and primary suture of common bile duct
Qing-Song Yang, Meng Zhang, Chang-Song Ma, Da Teng, Ao Li, Ji-Dong Dong, Xi-Fei Wang, Fu-Bao Liu
Qing-Song Yang, Meng Zhang, Chang-Song Ma, Da Teng, Ao Li, Ji-Dong Dong, Xi-Fei Wang, Department of Hepatopancreatobiliary Surgery, Affiliated Chuzhou Hospital of Anhui Medical University (The First People’s Hospital of Chuzhou), Chuzhou 239001, Anhui Province, China
Fu-Bao Liu, Department of Hepatobiliary and Pancreatic Surgery, General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
Author contributions: Yang QS contributed to the study design and data analysis; Zhang M, Ma CS, Teng D, Li A, Dong JD, and Wang XF assisted with data collection and interpretation; Liu FB provided critical revisions and clinical insights, supervised the research and served as the corresponding author; and all authors thoroughly reviewed and endorsed the final manuscript.
Supported by the Wannan Medical College Teaching Hospital Special Application for Scientific Research, No. WK2023JXYY036; and the Anhui Provincial Translational Clinical Medical Research Special Application, No. 202204295107020062.
Institutional review board statement: This study was approved by the Medical Ethics Committee of the First People’s Hospital of Chuzhou, approval No. (2024) Ethics Review [Biology] (29).
Informed consent statement: Informed consent was obtained from all participants, and the study was approved by Wannan Medical College.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data used in this study can be obtained from the corresponding author upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fu-Bao Liu, Chief Physician, PhD, Department of Hepatobiliary and Pancreatic Surgery, General Surgery, The First Affiliated Hospital of Anhui Medical University, No. 120 Wanshui Road, Nanqiao District, Hefei 230022, Anhui Province, China. 18955015210@163.com
Received: October 23, 2024 Revised: December 23, 2024 Accepted: January 8, 2025 Published online: March 27, 2025 Processing time: 123 Days and 23.7 Hours
Abstract
BACKGROUND
Bile leakage is a common complication following laparoscopic common bile duct exploration (LCBDE) with primary duct closure (PDC). Identifying and analyzing the risk factors associated with bile leakage is crucial for improving surgical outcomes.
AIM
To explore the value analysis of common risk factors for bile leakage after LCBDE and PDC, with a focus on strict adherence to indications.
METHODS
Clinical data of 106 cases undergoing LCBDE + PDC in the Hepatobiliary and Pancreatic Surgery Department (Division 1) of Chuzhou First People’s Hospital from April 2019 to March 2024 were collected. Retrospective and multiple factor regression analysis were conducted on common risk factors for bile leakage. The change in surgical time was analyzed using the cumulative summation (CUSUM) method, and the minimum number of cases required to complete the learning curve for PDC was obtained based on the proposed fitting curve by identifying the CUSUM maximum value.
RESULTS
Multifactor logistic regression analysis showed that fibrinous inflammation and direct bilirubin/indirect bilirubin were significant independent high-risk factors for postoperative bile leakage (P < 0.05). The time to drain removal and length of hospital stay in cases without bile leakage were significantly shorter than in cases with bile leakage (P < 0.05), with statistical significance. The CUSUM method indicated that a minimum of 51 cases were required for the surgeon to complete the learning curve (P = 0.023).
CONCLUSION
With a good assessment of duodenal papilla sphincter function, unobstructed bile-pancreatic duct convergence, exact stone clearance, and sufficient surgical experience to complete the learning curve, PDC remains the preferred method for bile duct closure and is worthy of clinical promotion.
Core Tip: This study identifies key risk factors for bile leakage following laparoscopic common bile duct exploration and primary duct closure (PDC). Through retrospective analysis and logistic regression, fibrinous exudation and direct bilirubin/indirect bilirubin were found to be significant independent risk factors. The cumulative summation method demonstrated that a minimum of 51 cases is required for surgeons to master the PDC technique effectively. Proper assessment of duodenal papilla function, ensuring bile duct patency, and achieving surgical proficiency are essential for minimizing complications. Adhering to these guidelines may optimize patient outcomes and promote PDC as a preferred method in clinical practice.
