title: A study of preoperative factors associated with a poor outcome following laparoscopic bile duct exploration.
abstract: BACKGROUND
  The aim of this study was to identify preoperative factors associated with poor outcome following laparoscopic bile duct exploration.
  
  
  METHODS
  Data regarding potential preoperative factors were collected prospectively and from a review of patient records of 436 patients who had undergone a laparoscopic bile duct exploration. A multivariate analysis was performed to identify significant predictors of five adverse outcomes: postoperative complication (stratified), conversion to open operation, prolonged hospital stay, bile leak following choledochotomy, and failure of surgical clearance of the duct.
  
  
  RESULTS
  The mean age was 57 years (range = 18-91) and 74% were female. No complications were experienced by 66.5% and 17% had a minor Clavien Grade I complication. There was one death. Clinically significant Clavien Grade II-V complications occurred more frequently in those of increasing age [OR = 1.03 (CI = 1.01-1.05), p = 0.02]. Increasing serum bilirubin [OR = 1.01 (CI = 1.00-1.01), p = 0.01] was associated with conversion to an open operation. Male sex [OR = 0.52 (CI = 0.27-0.99), p = 0.05], previous upper abdominal surgery [OR = 4.89 (CI = 1.10-21.74), p = 0.04], immunosuppressants [OR = 9.75 (CI = 1.06-89.93), p = 0.05], and a larger preoperative common bile duct diameter [OR = 1.16 (CI = 1.08-1.25), p < 0.001] were predictors of a prolonged hospital stay. No factors were identified as predictors of a controlled bile leak. Previous failed ERCP was not associated with adverse outcome.
  
  
  CONCLUSIONS
  Laparoscopic exploration of the bile duct is safe but age, comorbidity, and degree of jaundice increase the risk slightly.
authors.affiliation: Department of Surgery, Southmead Hospital, Bristol, BS10 5NB, UK. hamish.noble@nhs.net
authors.forename: Hamish
authors.initials: H
authors.lastname: Noble
authors.forename: Elise
authors.initials: E
authors.lastname: Whitley
authors.forename: Sally
authors.initials: S
authors.lastname: Norton
authors.forename: Michael
authors.initials: M
authors.lastname: Thompson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000453:epidemiology; D001646:Bile; D001652:Bile Ducts / Q000601:surgery*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D042883:Choledocholithiasis / Q000601:surgery; D002768:Choledochostomy / Q000009:adverse effects; D002769:Cholelithiasis / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D006801:Humans; D007813:Laparotomy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011300:Preoperative Care; D011446:Prospective Studies; D012140:Respiratory Tract Diseases / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013105:Sphincterotomy, Transduodenal / Q000009:adverse effects; D017211:Treatment Failure; D016055:Urinary Retention / Q000453:epidemiology / Q000209:etiology; D055815:Young Adult