A study of preoperative factors associated with a poor outcome following laparoscopic bile duct exploration

Abstract

Background: The aim of this study was to identify preoperative factors associated with poor outcome following laparoscopic bile duct exploration.

Methods: Data regarding potential preoperative factors were collected prospectively and from a review of patient records of 436 patients who had undergone a laparoscopic bile duct exploration. A multivariate analysis was performed to identify significant predictors of five adverse outcomes: postoperative complication (stratified), conversion to open operation, prolonged hospital stay, bile leak following choledochotomy, and failure of surgical clearance of the duct.

Results: The mean age was 57 years (range = 18-91) and 74% were female. No complications were experienced by 66.5% and 17% had a minor Clavien Grade I complication. There was one death. Clinically significant Clavien Grade II-V complications occurred more frequently in those of increasing age [OR = 1.03 (CI = 1.01-1.05), p = 0.02]. Increasing serum bilirubin [OR = 1.01 (CI = 1.00-1.01), p = 0.01] was associated with conversion to an open operation. Male sex [OR = 0.52 (CI = 0.27-0.99), p = 0.05], previous upper abdominal surgery [OR = 4.89 (CI = 1.10-21.74), p = 0.04], immunosuppressants [OR = 9.75 (CI = 1.06-89.93), p = 0.05], and a larger preoperative common bile duct diameter [OR = 1.16 (CI = 1.08-1.25), p < 0.001] were predictors of a prolonged hospital stay. No factors were identified as predictors of a controlled bile leak. Previous failed ERCP was not associated with adverse outcome.

Conclusion: Laparoscopic exploration of the bile duct is safe but age, comorbidity, and degree of jaundice increase the risk slightly.