Huang XX, Wu JY, Bai YN, Wu JY, Lv JH, Chen WZ, Huang LM, Huang RF, Yan ML. Outcomes of laparoscopic bile duct exploration for choledocholithiasis with small common bile duct. World J Clin Cases 2021; 9(8): 1803-1813 [PMID: 33748229 DOI: 10.12998/wjcc.v9.i8.1803]
Corresponding Author of This Article
Mao-Lin Yan, PhD, Assistant Professor, Doctor, Department of Hepatobiliary and Pancreatic Surgery, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, No. 134 Dongjie Road, Gulou District, Fuzhou 350001, Fujian Province, China. yanmaolin74@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
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/
Xiao-Xiao Huang, Jia-Yi Wu, Yan-Nan Bai, Jun-Yi Wu, Jia-Hui Lv, Wei-Zhao Chen, Li-Ming Huang, Rong-Fa Huang, Mao-Lin Yan, Department of Hepatobiliary and Pancreatic Surgery, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou 350001, Fujian Province, China
Author contributions: Huang XX and Wu JY designed the study and drafted the manuscript; Bai YN and Wu JY collected and analyzed the data; Lv JH and Chen WZ collected the data; Huang LM and Huang RF revised the manuscript for important intellectual content; Huang XX and Yan ML made substantial contributions to conception, design, and coordination of the study and gave final approval of the version to be published; All authors have read and approved the final manuscript.
Institutional review board statement: This study was approved by the institutional review board of the Fujian Provincial Hospital
Informed consent statement: All involved persons provided written or verbal informed consent prior to study inclusion.
Conflict-of-interest statement: No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at yanmaolin74@163.com.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Mao-Lin Yan, PhD, Assistant Professor, Doctor, Department of Hepatobiliary and Pancreatic Surgery, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, No. 134 Dongjie Road, Gulou District, Fuzhou 350001, Fujian Province, China. yanmaolin74@163.com
Received: December 5, 2020 Peer-review started: December 5, 2020 First decision: December 21, 2020 Revised: January 2, 2021 Accepted: January 26, 2021 Article in press: January 26, 2021 Published online: March 16, 2021 Processing time: 89 Days and 18.7 Hours
ARTICLE HIGHLIGHTS
Research background
Laparoscopic common bile duct (CBD) exploration (LCBDE) combined with cholecystectomy (LC) is a common therapeutic modality for the management of CBD stones (CBDS). Over time, LCBDE + LC is mainly performed for choledocholithiasis with CBD diameter of larger than 10 mm. However, it remains unclear whether LCBDE is feasible or safe for those with small CBD (CBD diameter ≤ 8 mm).
Research motivation
Some clinical practitioners have argued that LCBDE for small CBD may be more likely to lead to postoperative bile leak and CBD stenosis. We wanted to investigate these issues to help guide clinicians in efforts to improve management of CBDS, especially for those with small CBD.
Research objectives
The retrospective study is aimed to compare the clinical outcomes of large CBD group vs small CBD group to investigate the feasibility and safety of LCBDE for choledocholithiasis with small CBD.
Research methods
This study includes 257 patients with cholecystolithiasis who met the criteria. The short-term and long-term clinical outcomes were compared between the large CBD group and the small CBD group. Propensity score matching (1:1) was performed to adjust for the effects of confounding factors.
Research results
There was no significant difference in operating time, intraoperative blood loss, conversion to laparotomy, and rate of residual CBDS between large CBD group and small CBD group. LCBDE for small CBD would not increase the risk of postoperative bile leak and CBD stenosis compared with large CBD.
Research conclusions
Primary CBD closure following LCBDE + LC is a safe and effective approach to the management of choledocholithiasis with small CBD, as long as appropriate cases are selected, and does not increase the short-term or long-term complications compared with choledocholithiasis with large CBD.
Research perspectives
LCBDE + LC can be performed safely for choledocholithiasis with small CBD without increasing the risk of postoperative bile leak and CBD stenosis. Additional randomized controlled trials are needed to validate further these findings.
