Laparoscopic surgery for gallstones or common bile duct stones: A stably safe and feasible surgical strategy for patients with a history of upper abdominal surgery

Shaojie Yang; Shuodong Wu; Wanlin Dai; Liwei Pang; Yaofeng Xie; Tengqi Ren; Xiaolin Zhang; Shiyuan Bi; Yuting Zheng; Jingnan Wang; Yang Sun; Zhuyuan Zheng; Jing Kong

doi:10.3389/fsurg.2022.991684

Laparoscopic surgery for gallstones or common bile duct stones: A stably safe and feasible surgical strategy for patients with a history of upper abdominal surgery

Front Surg. 2022 Sep 30:9:991684. doi: 10.3389/fsurg.2022.991684. eCollection 2022.

Authors

Shaojie Yang¹, Shuodong Wu¹, Wanlin Dai², Liwei Pang³, Yaofeng Xie⁴, Tengqi Ren⁵, Xiaolin Zhang¹, Shiyuan Bi¹, Yuting Zheng¹, Jingnan Wang¹, Yang Sun¹, Zhuyuan Zheng¹, Jing Kong¹

Affiliations

¹ Biliary Surgery (2nd General) Unit, Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China.
² Innovation Institute of China Medical University, Shenyang, China.
³ Breast Surgery Unit, Department of General Surgery, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China.
⁴ Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China.
⁵ Department of Urinary Surgery, Taizhou Enze Medical Center (Group) Enze Hospital, Taizhou, China.

Abstract

Backgrounds/aims: A history of upper abdominal surgery has been identified as a relative contraindication for laparoscopy. This study aimed to compare the clinical efficacy and safety of laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) in patients with and without previous upper abdominal surgery.

Methods: In total, 131 patients with previous upper abdominal surgery and 64 without upper abdominal surgery underwent LC or LCBDE between September 2017 and September 2021 at the Shengjing Hospital of China Medical University. Patients with previous upper abdominal surgery were divided into four groups: group A included patients with previous right upper abdominal surgery who underwent LC (n = 17), group B included patients with previous other upper abdominal surgery who underwent LC (n = 66), group C included patients with previous right upper abdominal surgery who underwent LCBDE (n = 30), and group D included patients with previous other upper abdominal surgery who underwent LCBDE (n = 18). Patient demographics and perioperative outcomes were retrospectively analyzed.

Results: The preoperative liver function indexes showed no significant difference between the observation and control groups. For patients who underwent LC, groups A and B had more abdominal adhesions than the control group. One case was converted to open surgery in each of groups A and B. There was no statistical difference in operation time, estimated blood loss, postoperative hospital stay, and drainage volume. For patients who underwent LCBDE, groups C and D had more estimated blood loss than the control group (group C, 41.33 ± 50.84 vs. 18.97 ± 13.12 ml, p = 0.026; group D, 66.11 ± 87.46 vs. 18.97 ± 13.12 ml, p = 0.036). Compared with the control group, group C exhibited longer operative time (173.87 ± 60.91 vs. 138.38 ± 57.38 min, p = 0.025), higher drainage volume (296.83 ± 282.97 vs. 150.83 ± 127.04 ml, p = 0.015), and longer postoperative hospital stay (7.97 ± 3.68 vs. 6.17 ± 1.63 days, p = 0.021). There was no mortality in all groups.

Conclusions: LC or LCBDE is a safe and feasible procedure for experienced laparoscopic surgeons to perform on patients with previous upper abdominal surgery.

Keywords: abdominal adhesion; conversion to open surgery; laparoscopic cholecystectomy; laparoscopic common bile duct exploration; previous upper abdominal surgery.