title: Laparoscopic Common Bile Duct Exploration Versus Open Approach in Cirrhotic Patients with Choledocholithiasis: A Retrospective Study.
abstract: OBJECTIVE
  To evaluate the safety and benefits of laparoscopic common bile duct exploration (LCBDE) compared with open approach (OCBDE) in cirrhotic patients.
  
  
  METHODS
  Between January 2009 and December 2012, a total of 113 cirrhotic patients with choledocholithiasis underwent common bile duct (CBD) explorations in our department. There were two groups of patients: A:LCBDE (n = 61) and B:OCBDE (n = 52). Patients' demographic characteristics, surgical data, postoperative outcomes, and long-term results were retrospectively collected and analyzed.
  
  
  RESULTS
  There were no significant differences between the two groups in the demographic characteristics or preoperative status. The transcystic approach was successfully performed in 52 (46.0%) patients (group A:34, group B:20), whereas choledochotomy was successful in 59 (54.0%) patients (group A:27, group B:32). The differences between group A and group B in terms of surgical time (124.9 ± 34.2 minutes versus 132.6 ± 48.6 minutes, P = .323), stone clearance rate (93.4% versus 94.2%, P > .05), short-term complication rate (9.8% versus 13.4%, P = .547), and recurrent stone rate (6.6% versus 5.8%, P > .05) were not statistically significant. However, group A suffered less blood loss [95 (60-200) mL versus 200 (90-450) mL, P < .001] and shorter length of hospital stay (4.7 ± 2.5 days versus 11.3 ± 3.1 days, P < .001) than group B. In the LCBDE group, 4 (6.6%) patients were converted due to heavy inflammation and severe adhesions. No mortality, biliary injury, or stricture occurred during follow-up.
  
  
  CONCLUSIONS
  LCBDE can be safely performed in patients with Child-Pugh A or B cirrhosis and choledocholithiasis, with considerable efficiency, minimal short-term complications, and acceptable long-term outcomes. LCBDE has the advantages over open CBD exploration of less bleeding and reduced length of hospital stay.
authors: 1 Department of General Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai, China .
authors: Liang
authors: L
authors: Gui
authors: 2 Department of General Surgery, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai, China .
authors: Ye
authors: Y
authors: Liu
authors: 2 Department of General Surgery, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai, China .
authors: Jun
authors: J
authors: Qin
authors: 1 Department of General Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai, China .
authors: Lei
authors: L
authors: Zheng
authors: 1 Department of General Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai, China .
authors: Yi-Jun
authors: YJ
authors: Huang
authors: 1 Department of General Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai, China .
authors: Yue
authors: Y
authors: He
authors: 1 Department of General Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai, China .
authors: Wen-Sheng
authors: WS
authors: Deng
authors: 1 Department of General Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai, China .
authors: Bin-Bin
authors: BB
authors: Qian
authors: 1 Department of General Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai, China .
authors: Meng
authors: M
authors: Luo
mesh_terms: D000328:Adult; D000368:Aged; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D042883:Choledocholithiasis / Q000150:complications / Q000601:surgery*; D003135:Common Bile Duct / Q000601:surgery*; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay / Q000706:statistics & numerical data; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: common bile duct; exploration; laparoscopic