Outcomes of laparoscopic bile duct exploration for choledocholithiasis with small common bile duct

doi:10.12998/wjcc.v9.i8.1803

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World Journal of Clinical Cases

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Retrospective Study

World J Clin Cases. Mar 16, 2021; 9(8): 1803-1813
Published online Mar 16, 2021. doi: 10.12998/wjcc.v9.i8.1803

Outcomes of laparoscopic bile duct exploration for choledocholithiasis with small common bile duct

Xiao-Xiao Huang, Jia-Yi Wu, Yan-Nan Bai, Jun-Yi Wu, Jia-Hui Lv, Wei-Zhao Chen, Li-Ming Huang, Rong-Fa Huang, Mao-Lin Yan

Xiao-Xiao Huang, Jia-Yi Wu, Yan-Nan Bai, Jun-Yi Wu, Jia-Hui Lv, Wei-Zhao Chen, Li-Ming Huang, Rong-Fa Huang, Mao-Lin Yan, Department of Hepatobiliary and Pancreatic Surgery, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou 350001, Fujian Province, China

Author contributions: Huang XX and Wu JY designed the study and drafted the manuscript; Bai YN and Wu JY collected and analyzed the data; Lv JH and Chen WZ collected the data; Huang LM and Huang RF revised the manuscript for important intellectual content; Huang XX and Yan ML made substantial contributions to conception, design, and coordination of the study and gave final approval of the version to be published; All authors have read and approved the final manuscript.

Institutional review board statement: This study was approved by the institutional review board of the Fujian Provincial Hospital

Informed consent statement: All involved persons provided written or verbal informed consent prior to study inclusion.

Conflict-of-interest statement: No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at yanmaolin74@163.com.

Corresponding author: Mao-Lin Yan, PhD, Assistant Professor, Doctor, Department of Hepatobiliary and Pancreatic Surgery, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, No. 134 Dongjie Road, Gulou District, Fuzhou 350001, Fujian Province, China. yanmaolin74@163.com

Received: December 5, 2020
Peer-review started: December 5, 2020
First decision: December 21, 2020
Revised: January 2, 2021
Accepted: January 26, 2021
Article in press: January 26, 2021
Published online: March 16, 2021
Processing time: 89 Days and 18.7 Hours

ARTICLE HIGHLIGHTS

Research background

Laparoscopic common bile duct (CBD) exploration (LCBDE) combined with cholecystectomy (LC) is a common therapeutic modality for the management of CBD stones (CBDS). Over time, LCBDE + LC is mainly performed for choledocholithiasis with CBD diameter of larger than 10 mm. However, it remains unclear whether LCBDE is feasible or safe for those with small CBD (CBD diameter ≤ 8 mm).

Research motivation

Some clinical practitioners have argued that LCBDE for small CBD may be more likely to lead to postoperative bile leak and CBD stenosis. We wanted to investigate these issues to help guide clinicians in efforts to improve management of CBDS, especially for those with small CBD.

Research objectives

The retrospective study is aimed to compare the clinical outcomes of large CBD group vs small CBD group to investigate the feasibility and safety of LCBDE for choledocholithiasis with small CBD.

Research methods

This study includes 257 patients with cholecystolithiasis who met the criteria. The short-term and long-term clinical outcomes were compared between the large CBD group and the small CBD group. Propensity score matching (1:1) was performed to adjust for the effects of confounding factors.

Research results

There was no significant difference in operating time, intraoperative blood loss, conversion to laparotomy, and rate of residual CBDS between large CBD group and small CBD group. LCBDE for small CBD would not increase the risk of postoperative bile leak and CBD stenosis compared with large CBD.

Research conclusions

Primary CBD closure following LCBDE + LC is a safe and effective approach to the management of choledocholithiasis with small CBD, as long as appropriate cases are selected, and does not increase the short-term or long-term complications compared with choledocholithiasis with large CBD.

Research perspectives

LCBDE + LC can be performed safely for choledocholithiasis with small CBD without increasing the risk of postoperative bile leak and CBD stenosis. Additional randomized controlled trials are needed to validate further these findings.