title: Laparoscopic common bile duct exploration in patients with previous upper abdominal operations.
abstract: OBJECTIVE
  We aimed to to evaluate the feasibility of laparoscopic common bile duct exploration (LCBDE) in patients with previous upper abdominal surgery.
  
  
  METHODS
  Retrospective analysis was performed on data from the attempted laparoscopic common bile duct exploration in 44 patients. Among them, 5 patients with previous lower abdominal operation were excluded. 39 patients were divided into two groups according to presence of previous upper abdominal operation; Group A: patients without history of abdominal operation. (n=27), Group B: patients with history of upper abdominal operation. Both groups (n=12) were compared to each other, with respect to clinical characteristics, operation time, postoperative hospital stay, open conversion rate, postoperative complication, duct clearance and mortality.
  
  
  RESULTS
  All of the 39 patients received laparoscopic common bile duct exploration and choledochotomy with T-tube drainage (n=38 [97.4%]) or with primary closure (n=1). These two groups were not statistically different in gender, mean age and presence of co-morbidity, mean operation time (164.5±63.1 min in group A and 134.8±45.2 min in group B, p=0.18) and postoperative hospital stay (12.6±5.7 days in group A and 9.8±2.9 days in group B, p=0.158). Duct clearance and complication rates were comparable (p>0.05). 4 cases were converted to open in group A and 1 case in group B respectively. In group A (4 of 27 (14.8%) and 1 of 12 (8.3%) in group B, p=0.312) Trocar or Veress needle related complication did not occur in either group.
  
  
  CONCLUSIONS
  LCBDE appears to be a safe and effective treatment even in the patients with previous upper abdominal operation if performed by experienced laparoscopic surgeon, and it can be the best alternative to failed endoscopic retrograde cholangiopancreatography for difficult cholelithiasis.
authors.affiliation: Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea. ; Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Keong Won
authors.initials: KW
authors.lastname: Yun
authors.affiliation: Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: Young Joon
authors.initials: YJ
authors.lastname: Ahn
authors.affiliation: Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: Hae Won
authors.initials: HW
authors.lastname: Lee
authors.affiliation: Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: In Mok
authors.initials: IM
authors.lastname: Jung
authors.affiliation: Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: Jung Kee
authors.initials: JK
authors.lastname: Chung
authors.affiliation: Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: Seung Chul
authors.initials: SC
authors.lastname: Heo
authors.affiliation: Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: Ki-Tae
authors.initials: KT
authors.lastname: Hwang
authors.affiliation: Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: Hye Seong
authors.initials: HS
authors.lastname: Ahn
keywords: Laparoscopic common bile duct exploration; Previous surgery