Does the surgeon's experience influence the outcome of laparoscopic treatment of common bile duct stones?
BACKGROUND
The aim of this study was to assess laparoscopic treatment of choledocholithiasis with respect to the surgeon's experience.


METHODS
From January 1994 to December 2006, 130 patients underwent laparoscopic treatment for common bile duct stones found with intraoperative cholangiography. Two types of surgeons were defined: junior surgeons with fewer than ten laparoscopic common bile duct explorations performed and experienced surgeons with more than ten. The two patient populations (n = 65 in each group) were similar in regard to demographic data, clinical presentations (complicated or not), and ASA score.


RESULTS
Results show that junior surgeons had significantly more patients with a common bile duct (CBD) diameter <7 mm compared to experienced surgeons (66% vs. 38%; p = 0.002). Primary closure of choledochotomy was performed by senior rather than junior surgeons significantly more often (87.5% vs. 69%; p = 0.05). Mean operating time was found to be longer for junior operators than for experienced surgeons (220 ± 71 min vs. 169 ± 71 min; p = 0.0006). There was no difference between group 1 (juniors) and group 2 (experienced surgeons) in regard to laparotomy conversion rate (9% vs. 1.5%; p = 0.1), complete common bile duct clearance (98% vs. 100%, p = ns), postoperative complications (two bile leaks in group 1 and one in group 2), and hospital stay (9 days vs. 7.5 days). In multivariate analysis, the transcystic approach was not influenced by the surgeon's experience. Experienced surgeons performed choledochotomy with primary closure more easily [RR = 3 (range = 1.1-8); p = 0.04]. Complicated presentations [RR = 2 (0.7-3); p = 0.08] and CBD diameter [RR = 2.5 (0.96-7); p = 0.06] influenced the choice of type of closure of choledochotomy without any significant value.


CONCLUSIONS
Surgeon's experience influenced operating time and type of choledochotomy closure performed but had no influence on postoperative results of the laparoscopic treatment of common bile duct stones.
Department of Digestive Surgery, St. Eloi Hospital, Montpellier, France. astrid.herrero@uclouvain.be
Astrid
A
Herrero
Claire
C
Philippe
Françoise
F
Guillon
Bertrand
B
Millat
Frédéric
F
Borie
D017081:Cholecystectomy, Laparoscopic / Q000592:standards* / Q000706:statistics & numerical data; D042883:Choledocholithiasis / Q000601:surgery*; D002983:Clinical Competence / Q000592:standards*; D005762:Gastroenterology / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D058106:Wound Closure Techniques / Q000592:standards