Published online Mar 27, 2025. doi: 10.4240/wjgs.v17.i3.102190
Revised: December 23, 2024
Accepted: January 8, 2025
Published online: March 27, 2025
Processing time: 123 Days and 23.7 Hours
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.
To explore the value analysis of common risk factors for bile leakage after LCBDE and PDC, with a focus on strict adherence to indications.
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.
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).
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.