Moving the needle for laparoscopic common bile duct exploration: defining obstacles for the path forward

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

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.