Emergency laparoscopic common bile duct exploration and analysis of risk factors for post-procedure leak: A seven years’ experience

INTRODUCTION: Laparoscopic common bile duct exploration (LCBDE) for choledocholithiasis in the emergency setting is challenging and technically demanding. This study aims to assess the safety and efficacy of emergency LCBDE and to analyze risk factors for post-operative bile leak.
METHODS: A retrospective data collection was done over medical notes and electronic records of the patient for the period between January 2011 to October 2017. Merelythe emergency LCBDEs were involved in this series. All of the emergency LCBDEs performed were on the index admission. Univariate and multivariate analysis were caried out for the risk factors of bile leak post-procedure.
RESULTS: 78 patients were undergone emergency LCBDE in the given period. 76 patients had a laparoscopic cholecystectomy as well as emergency LCBDE; two patients had previously undergone laparoscopic cholecystectomy. While choledochotomy was performed in 62 patients, 16 patients had a transcystic approach. All emergency LCBDEs were initiated laparoscopically, three (4%) patients had to be converted to open procedure due to adhesions (one) and impacted stones (two). In 72 patients (%89), the CBD was cleared in 72 patients (89 %) and 9 patients were considered to be in need of post-operative ERCP (6 for retained stone, 2 showing clear ducts, and 1 for continuous bile leak). Normal CRP and bilirubin values were significantly associated with post-operative bile leak.
DISCUSSION AND CONCLUSION: Emergency laparoscopic common bile duct exploration is safe, feasible, and efficient in the emergency management of common bile duct stones.