title: Risk factors for bile leakage after primary closure following laparoscopic common bile duct exploration: a retrospective cohort study.
abstract: BACKGROUND
  Primary closure following laparoscopic common bile duct exploration (LCBDE) has been widely adopted because of the efficacy and safety in treatment of common bile duct (CBD) stones. However, the risk factors for bile leakage, the most common complication after primary closure, has not been clarified yet.
  
  
  METHODS
  A retrospective cohort study of patients who underwent LCBDE with primary closure after choledochotomy between Feb. 2012 and Jun. 2016 was performed. Risk factors for bile leakage were identified by logistic regression inculding demographic factors, preoperative condition and surgical details.
  
  
  RESULTS
  Between Feb. 2012 and Jun. 2016, a total of 265 LCBDE procedures were applied in our hospital and 141 patients with primary closure were included in this study. Bile leakage occurred in 11.3% (16/141) of these patients, and happened more frequently in patients with slender CBD (<1 vs ≥1 cm, 31.6% vs 7.0%, p = 0.04) and those managed by inexperienced surgeons (initial 70 cases vs later cases, 17.1% vs 5.6%, p = 0.04). After multivariable regression, the diameter of CBD [OR 95% CI, 3.799 (1.081-13.349), p = 0.04] and experience of surgeons [OR 95% CI, 4.228 (1.330-13.438), p = 0.03] were significantly related to bile leakage.
  
  
  CONCLUSIONS
  Slender CBD and inexperienced surgeons were the high risk factors for bile leakage after primary closure following LCBDE.
authors.affiliation: Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, People's Republic of China. Liudongbin90266@sohu.com.
authors.forename: Dongbin
authors.initials: D
authors.lastname: Liu
authors.affiliation: Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, People's Republic of China.
authors.forename: Feng
authors.initials: F
authors.lastname: Cao
authors.affiliation: Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, People's Republic of China.
authors.forename: Jiafeng
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, People's Republic of China.
authors.forename: Dahua
authors.initials: D
authors.lastname: Xu
authors.affiliation: Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, People's Republic of China.
authors.forename: Yuehua
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, People's Republic of China.
authors.forename: Fei
authors.initials: F
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D001646:Bile; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects*; D003135:Common Bile Duct / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Bile leakage; Laparoscopic common bile duct exploration; Primary closure