Reoperation of the biliary tract by laparoscopy: an analysis of 39 cases.
BACKGROUND
Previously, prior biliary tract surgery was considered a contraindication to laparoscopic biliary tract reoperation. In this paper, we present our experience with laparoscopic biliary tract reoperation for patients with the choledocholithiasis for whom the endoscopic sphincterotomy has failed or is contraindicated.


METHODS
A retrospective analysis was performed on data from the attempted laparoscopic reoperation of 39 patients, examining open conversion rates, operative times, complications, and length of hospital stay.


RESULTS
Of 39 cases, 38 were completed laparoscopically: 1 case required a conversion to the open operation because of difficulty in exposing the common bile duct. Mean operative time was 135 minutes. Mean postoperative hospital stay was 4 days. Procedures included 3 cases of laparoscopic residual gallbladder resection, 13 cases of laparoscopic common bile duct exploration and primary duct closure of choledochotomy, and 22 cases of laparoscopic common bile duct exploration and choledochotomy with T-tube drainage. There was 1 case of duodenal perforation during dissection, which was repaired laparoscopically. There were 2 cases of retained stones. Postoperative asymptomatic hypermalasia occurred in 3 cases. There were no complications due to port placement, no postoperative bleeding, bile or bowel leakage, and no mortality. At a mean follow-up time of 18 months, there was no recurrence or formation of duct stricture.


CONCLUSIONS
The laparoscopic biliary tract reoperation is safe and feasible for experienced laparoscopic surgeons and is an alternative choice for patients with choledocholithiasis for whom the endoscopic sphincterectomy has failed or is contraindicated.
Li
Libo
L
Department of General Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China. lilb@srrsh.com
Cai
Xiujun
X
Mou
Yiping
Y
Wei
Qi
Q
D000293:Adolescent; D000328:Adult; D000368:Aged; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D042883:Choledocholithiasis / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome