Analysis of risk factors for bile leakage after laparoscopic exploration and primary suture of common bile duct

Abstract

Background: Bile leakage is a common complication following laparoscopic common bile duct exploration (LCBDE) with primary duct closure (PDC). Identifying and analyzing the risk factors associated with bile leakage is crucial for improving surgical outcomes.

Aim: To explore the value analysis of common risk factors for bile leakage after LCBDE and PDC, with a focus on strict adherence to indications.

Methods: Clinical data of 106 cases undergoing LCBDE + PDC in the Hepatobiliary and Pancreatic Surgery Department (Division 1) of Chuzhou First People's Hospital from April 2019 to March 2024 were collected. Retrospective and multiple factor regression analysis were conducted on common risk factors for bile leakage. The change in surgical time was analyzed using the cumulative summation (CUSUM) method, and the minimum number of cases required to complete the learning curve for PDC was obtained based on the proposed fitting curve by identifying the CUSUM maximum value.

Results: Multifactor logistic regression analysis showed that fibrinous inflammation and direct bilirubin/indirect bilirubin were significant independent high-risk factors for postoperative bile leakage (P < 0.05). The time to drain removal and length of hospital stay in cases without bile leakage were significantly shorter than in cases with bile leakage (P < 0.05), with statistical significance. The CUSUM method indicated that a minimum of 51 cases were required for the surgeon to complete the learning curve (P = 0.023).

Conclusion: With a good assessment of duodenal papilla sphincter function, unobstructed bile-pancreatic duct convergence, exact stone clearance, and sufficient surgical experience to complete the learning curve, PDC remains the preferred method for bile duct closure and is worthy of clinical promotion.

Keywords: Bile leakage; Cumulative summation; Laparoscopic common bile duct exploration; Primary duct closure; Risk factor analysis.

Figure 1

Learning curve. The samples were sorted according to the order of surgery and the serial number was edited. The % scatter plot was drawn with cumulative summation value as the vertical axis and the number of cases as the horizontal axis. CUSUM: Cumulative summation, .

Figure 2

Gallbladder inflammation. A: The fibrous membrane covering the bile duct has not yet affected the patency of the nipple; B: The fibrous membrane in the bile duct affects the patency of the nipple; C: Nodular hyperplasia of bile duct mucosa (local); D: Nodular hyperplasia of bile duct mucosa (involving the entire bile duct mucosa).