A study of preoperative factors associated with a poor outcome following laparoscopic bile duct exploration

Noble, H., Whitley, E. , Norton, S. and Thompson, M. (2011) A study of preoperative factors associated with a poor outcome following laparoscopic bile duct exploration. Surgical Endoscopy, 25(1), pp. 130-139. (doi: 10.1007/s00464-010-1146-3)

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Background: The aim of this study was to identify preoperative factors associated with poor outcome following laparoscopic bile duct exploration. Methods: Data regarding potential preoperative factors were collected prospectively and from a review of patient records of 436 patients who had undergone a laparoscopic bile duct exploration. A multivariate analysis was performed to identify significant predictors of five adverse outcomes: postoperative complication (stratified), conversion to open operation, prolonged hospital stay, bile leak following choledochotomy, and failure of surgical clearance of the duct. Results: The mean age was 57 years (range = 18–91) and 74% were female. No complications were experienced by 66.5% and 17% had a minor Clavien Grade I complication. There was one death. Clinically significant Clavien Grade II–V complications occurred more frequently in those of increasing age [OR = 1.03 (CI = 1.01–1.05), p = 0.02]. Increasing serum bilirubin [OR = 1.01 (CI = 1.00–1.01), p = 0.01] was associated with conversion to an open operation. Male sex [OR = 0.52 (CI = 0.27–0.99), p = 0.05], previous upper abdominal surgery [OR = 4.89 (CI = 1.10–21.74), p = 0.04], immunosuppressants [OR = 9.75 (CI = 1.06–89.93), p = 0.05], and a larger preoperative common bile duct diameter [OR = 1.16 (CI = 1.08–1.25), p < 0.001] were predictors of a prolonged hospital stay. No factors were identified as predictors of a controlled bile leak. Previous failed ERCP was not associated with adverse outcome. Conclusion: Laparoscopic exploration of the bile duct is safe but age, comorbidity, and degree of jaundice increase the risk slightly.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Whitley, Dr Elise
Authors: Noble, H., Whitley, E., Norton, S., and Thompson, M.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
Journal Name:Surgical Endoscopy
ISSN (Online):1432-2218

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