Laparoscopic common bile duct exploration in patients with complicated cholecystitis: a safety and feasibility study.
BACKGROUND
Laparoscopic cholecystectomy (LC) with common bile duct exploration (LCBDE) is nowadays a preferred one-stage treatment. However, the influence of complicated cholecystitis (CC) on LCBDE has rarely been addressed. In the present study we aimed to verify whether severe gallbladder inflammation would adversely affect the outcome of LCBDE.


METHODS
From 2008 to 2011, all patients undergoing LC and LCBDE at China Medical University Hospital were included. Patients were divided into two groups based on the severity of cholecystitis. Those with unstable hemodynamics and co-morbidities who were deemed unfit for general anesthesia were excluded. Patient demographics, surgical results, and outcome were compared between the groups.


RESULTS
During the study period, 117 patients diagnosed with cholecystitis were found to have common bile duct (CBD) stones and underwent LC + LCBDE. Of these 117 patients, 87 had uncomplicated cholecystitis (UC) and the remaining 30 patients had CC. There was no demographic difference between the groups, but for patients with CC there were marginally longer operative times (190 vs. 223 min, p = 0.141), more blood loss (10 vs. 150 ml, p < 0.05), and longer postoperative hospital stays (6 vs. 7 days, p < 0.05). The risk of developing major intraoperative complications was not greater for those with CC. Conversion to open cholecystectomy was necessary in a total of 12 cases (10 %) with an overall 1 % mortality rate.


CONCLUSIONS
Complicated cholecystitis was not a contraindication for LCBDE. Complete stone clearance can be achieved in a substantial number of cases with an acceptable complication rate. Further prospective randomized studies are required to validate its long-term safety.
Department of Trauma and Emergency Surgery, China Medical University Hospital, Taichung 404, Taiwan. carfishcat@yahoo.com.tw
Hung-Chieh
HC
Lo
Yu-Chun
YC
Wang
Jui-Chien
JC
Huang
Cheng-Hsiung
CH
Hsu
Shih-Chi
SC
Wu
Chi-Hsun
CH
Hsieh
D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D002764:Cholecystitis / Q000150:complications / Q000601:surgery*; D003135:Common Bile Duct; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index