Laparoscopic common bile duct exploration in patients with previous
upper abdominal surgery
· Gen Sun
· Le Hong
· Xiaohua Li
· Yong Li
· Weidong Xiao
Received: 2 January 2018 / Accepted: 29 May 2018
© Springer Science+Business Media, LLC, part of Springer Nature 2018
Background Although patients with previous upper abdominal surgery are no longer considered as a contraindication in
laparoscopic surgery, laparoscopic common bile duct exploration (LCBDE) for these patients is still controversial. The aim
of this study was to evaluate the safety and eﬀectiveness of LCBDE for patients with previous upper abdominal surgery.
Methods Two hundred and seventeen patients with common bile duct stones who underwent LCBDE in our institution from
January 2010 to September 2017 were enrolled in the retrospective study. They were divided into two groups: group A,
with previous upper abdominal surgery (n = 50) and group B, without previous upper abdominal surgery (n = 167). Patients’
demographic, intraoperative, and postoperative outcomes were retrospectively analyzed.
Results Group A exhibited a longer operative time compared to group B (179.7 ± 61.5 vs. 156.0 ± 46.8 min, p = 0.014).
There was no signiﬁcant diﬀerence in intraoperative blood loss (123.9 ± 99.5 vs. 99.5 ± 84.7 mL, p = 0.087), postoperative
hospital stay (7.4 ± 2.6 vs. 6.8 ± 2.3 d, p = 0.193), and overall complication rate (8.0 vs. 5.4%, p = 0.732) between the two
groups. There was no mortality in both groups. The initial stone clearance rate showed no signiﬁcant diﬀerence between the
two groups (98.0 vs. 98.2%, p = 1.000), and the ﬁnal stone clearance rate was 100% in both groups (p = 1.000). The stone
recurrence rate had no signiﬁcant diﬀerence between the two groups (2.0 vs. 2.4%, p = 1.000). The conversion rate was
comparable between group A and group B (6.0 vs. 4.8%, p = 0.718).
Conclusions LCBDE is a safe and feasible procedure for patients with previous upper abdominal surgery. The keys of this
procedure are carefully separating the adhesions and clearly exposing the common bile duct, and using a variety of methods
to remove the stones.
Keywords Laparoscopic common bile duct exploration · Common bile duct stone · Previous abdominal surgery · Gallstone
Common bile duct stones (CBDS) is one of the most
common biliary diseases worldwide, which accounts for
approximately 10–15% of patients with cholelithiasis .
General, there are three surgical procedures for the treat-
ment of CBDS including open common bile duct explora-
tion (OCBDE), endoscopic retrograde cholangiopancrea-
tography plus laparoscopic cholecystectomy (ERCP + LC),
and laparoscopic common bile duct exploration (LCBDE).
LCBDE has become more popular among these acceptable
options, with the advantages of preserving the function of
Oddi’s sphincter, a single-stage operation with fewer hospi-
tal admissions and a satisfactory stone clearance rate [2–4].
A history of previous open abdominal surgery increases
the potential complication rate and length of hospital stay
during subsequent laparoscopic surgery . Recently years,
with the development of laparoscopic skills and devices,
patients with previous upper abdominal surgery are no
longer considered as a contraindication in laparoscopic sur-
gery [6–9]. However, up to date, only a few studies involved
LCBDE for patients with previous upper abdominal surgery
[10–13], and its safety and feasibility have not been fully
evaluated. Therefore, this retrospective study was performed
and Other Interventional Techniques
Jisheng Zhu and Gen Sun have contributed equally to this work,
and both should be considered as ﬁrst author.
* Weidong Xiao
Department of General Surgery, The First Aﬃliated
Hospital of Nanchang University, No. 17 Yongwai Zhengjie,
Nanchang 330006, Jiangxi, China