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complications after laparoscopic common bile duct exploration (LCBDE) regarding the choledochotomy technique have not been adequately studied in the literature. Therefore, this study aimed to retrospectively analyze and compare the impact of choledochotomy techniques during LCBDE among patients with choledocholithiasis during the early and late postoperative periods.
Background: complications after laparoscopic common bile duct exploration (LCBDE) regarding the choledochotomy technique have not been adequately studied in the literature. Therefore, this study aimed to retrospectively analyze and compare the impact of choledochotomy techniques during LCBDE among patients with choledocholithiasis during the early and late postoperative periods.
Methods: from March 2014 to February 2018, 85 patients with choledocholithiasis (52 females and 33 males) were enrolled in this study. These patients were treated by LCBDE using various choledochotomy techniques, including scalpel or scissor (28 patients, 33%) in group I, using diathermy hook (35 patients, 41%) in group II, or using an ultrasonic device (22 patients, 26 %) in group III. Postoperative follow-up was done for assessment of all possible complications either early (within 3-6 months postoperatively), or late (2-6 years postoperatively) with meticulous observation and study of any relevant postoperative event.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group 1 | sharp choledochotomy by a scalpel or scissor |
| |
| Group 2 | choledochotomy by a diathermy hook |
| |
| Group 3 | choledochotomy by an ultrasonic device |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| choledochotomy techniques during LCBDE | Procedure |
|
| Measure | Description | Time Frame |
|---|---|---|
| biliary leakage/fistula | According to the international study group of liver surgery, bile leakage is defined as fluid with an elevated bilirubin level (3 times higher than the serum bilirubin measured at the same time) in the abdominal drain or the intra-abdominal fluid on or after POD 3, or as the need for radiologic intervention because of biliary collections or re-laparotomy resulting from biliary peritonitis | first postoperative 6 months up to 6 years postoperatively |
| biliary stricture | The biliary stricture is known as abnormal narrowing of the bile duct associated with the rising of cholestasis indexes. Additionally, it has required an invasive treatment such as ERCP, percutaneous transhepatic drainage, or re-surgery [16]. Biliary complications were diagnosed by trans-tubal cholangiography or through MRCP and could be managed conservatively, ERCP, if there is an accessible route, PTD or surgical intervention. | 2-6 years |
| Measure | Description | Time Frame |
|---|---|---|
| operative time | from incision to closure | from incision to closure |
| intraoperative bleeding | in mm | during surgery |
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Inclusion Criteria:
Exclusion Criteria:
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During the study period, 85 patients (52 females and 33 males) were enrolled in this study which they were complaining of manifestations of CBD stones and treated using laparoscopic approaches, using various choledochotomy techniques.
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| Name | Affiliation | Role |
|---|---|---|
| Emad Ali Ahmed, MD, PhD | Sohag University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Sohag University | Sohag | 82524 | Egypt |
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| ID | Term |
|---|---|
| D042883 | Choledocholithiasis |
| ID | Term |
|---|---|
| D003137 | Common Bile Duct Diseases |
| D001649 | Bile Duct Diseases |
| D001660 | Biliary Tract Diseases |
| D004066 | Digestive System Diseases |
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| conversion rate | from laparoscopy to open | during surgery |
| jaundice | missed stone | 2-6 years |
| wound sepsis | infection of the wound | 2-6 years |
| cholangitis | inflammation of the biliary system | 2-6 years |
| wound dehiscence | Gapped wound | 2-6 years |
| Peritoneal sepsis and abscess | peritonitis | first postoperative 6 months |
| Recurrent stones | recurrence | 2-6 years |
| D002769 | Cholelithiasis |