Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 21, 2016; 22(11): 3234-3241
Published online Mar 21, 2016. doi: 10.3748/wjg.v22.i11.3234
Negative short-term impact of intraoperative biliary lavage in patients with hepatolithiasis
Ou Jiang, Rong-Xing Zhou, Ke Yang, Chun-Xian Cai, Yu Liu, Nan-Sheng Cheng
Ou Jiang, Ke Yang, Chun-Xian Cai, Yu Liu, Department of Surgical Oncology, The Second People’s Hospital of Neijiang, Neijiang 641100, Sichuan Province, China
Rong-Xing Zhou, Nan-Sheng Cheng, Department of Biliary Surgery, West China Medical Center of Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Jiang O and Zhou RX contributed same work to this study; Cheng NS was the guarantor and designed research; Jiang O and Zhou RX performed research; Yang K participated in the acquisition; Cai CX and Liu Y performed the analysis, and interpretation of the data; Jiang O and Zhou RX drafted the manuscript; Cheng NS revised the article.
Supported by The Science and Technology Support Project of Sichuan Province, No. 2014SZ0002-10 and No. 2015FZ0076.
Institutional review board statement: This study is retrospective, it was approved by the review board of West China Hospital.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Nan-Sheng Cheng, MD, Department of Biliary Surgery, West China Medical Center of Sichuan University, No. 37 Guo Xue Valley, Chengdu 610041, Sichuan Province, China. zhourongxing@vip.163.com
Telephone: +86-28-85422465 Fax: +86-28-85422468
Received: May 28, 2015
Peer-review started: May 31, 2015
First decision: June 19, 2015
Revised: September 27, 2015
Accepted: December 8, 2015
Article in press: December 8, 2015
Published online: March 21, 2016
Processing time: 290 Days and 16.9 Hours
Abstract

AIM: To evaluate short-term outcomes following intraoperative biliary lavage for hepatolithiasis.

METHODS: A total of 932 patients who were admitted to the West China Medical Center of Sichuan University between January 2010 and January 2014 and underwent bile duct exploration and lithotomy were retrospectively included in our study. The patients were divided into the lavage group and the control group. Related pre-, intra-, and postoperative factors were recorded, analyzed, and compared between the two groups in order to verify the effects of biliary lavage on the short-term outcome of patients with hepatolithiasis.

RESULTS: Amongst the patients who were included, 678 patients with hepatolithiasis were included in the lavage group, and the other 254 patients were enrolled in the control group. Data analyses revealed that preoperative baseline and related intraoperative variables were not significantly different. However, patients who underwent intraoperative biliary lavage had prolonged postoperative hospital stays (6.67 d vs 7.82 d, P = 0.024), higher hospitalization fees (RMB 28437.1 vs RMB 32264.2, P = 0.043), higher positive rates of bacterial cultures from blood (13.3% vs 25.8%, P = 0.001) and bile (23.6% vs 40.7%, P = 0.001) samples, and increased usage of advanced antibiotics (26.3% vs 38.2%, P = 0.001). In addition, in the lavage group, more patients had fever (> 37.5 °C, 81.4% vs 91.1%, P = 0.001) and hyperthermia (> 38.5°C，39.7% vs 54.9%, P = 0.001), and higher white blood cell counts within 7 d after the operation compared to the control group.

CONCLUSION: Intraoperative biliary lavage might increase the risk of postoperative infection, while not significantly increasing gallstone removal rate.

Keywords: Hepatolithiasis; Biliary lavage; Postoperative infection

Core tip: Hepatolithiasis remains a prevalent disease in Asia-Pacific regions, and the most important treatment procedures are hepatectomy and intraoperative choledochofiberscopy combined with basket stone extraction Intraoperative biliary lavage is also a commonly used, simple, and effective procedure for the extraction of intrahepatic stones. However, few investigators have noted the potential risks associated with this method. In this study, we collected and analyzed the data, and the aim of this retrospective study was to evaluate the risks and short-term patient outcomes following intraoperative biliary lavage.