Is prophylactic gastrointestinal decompression necessary in patients undergoing laparoscopic common bile duct exploration?_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

HUO Chenglong , DENG Yan , WANG Shuai , ZHU Zhenxin ,  SUN Zhengang

Department of Hepatobiliary, Pancreatic, and Splenic Surgery, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, Jingzhou, Hubei 434020, P. R. China;

Corresponding author：

SUN Zhengang, Email: 669210966@qq.com

Keywords：

gastrointestinal decompression; laparoscopic common bile duct exploration; fast track surgery; prognosis

DOI：

10.7507/1007-9424.201812015

Video：

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Objective To investigate safety and feasibility of laparoscopic common bile duct exploration (LCBDE) without preoperative prophylactic gastrointestinal decompression.Methods A prospective study was conducted on the patients with choledocholithiasis and cholecystolithiasis scheduled to undergo LCBDE plus laparoscopic cholecystectomy in this hospital from January 2016 to December 2017. All the patients were randomly divided into a gastrointestinal decompression group and a non-gastrointestinal decompression group by the same researcher according to the random number table method. The general conditions, intraoperative status and postoperative status of patients in the two groups were compared.Results A total of 286 patients were enrolled in this study, including 120 in the non-gastrointestinal decompression group and 166 in the gastrointestinal decompression group. There were no significant differences in the general data such as the age, gender, smoking history, drinking history, preoperative complications, results of preoperative laboratory examination, and preoperative anesthesia score between the two groups (P>0.050). The time of oral feeding in the non-gastrointestinal decompression group was significantly earlier than that in the gastrointestinal decompression group (t=2.181, P=0.030). There were no significant differences in the bleeding volume, operative time, anal ventilation time, total hospitalization time, and postoperative hospitalization time between the two groups (P>0.050). The incidences of nausea/vomiting and poor appetite in the non-gastrointestinal decompression were significantly lower than those in the gastrointestinal decompression group (χ²=5.098, P=0.024; χ²=4.905, P=0.027). There were no significant differences in the incidences of other complications between the two groups (P>0.050).Conclusion From results of this study, prophylactic gastrointestinal decompression should not be recommended for patients undergoing LCBDE.

Citation： HUO Chenglong, DENG Yan, WANG Shuai, ZHU Zhenxin, SUN Zhengang. Is prophylactic gastrointestinal decompression necessary in patients undergoing laparoscopic common bile duct exploration?. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(4): 443-447. doi: 10.7507/1007-9424.201812015 Copy

1.	Gaignard E, Bergeat D, Courtin-Tanguy L, et al. Is systematic nasogastric decompression after pancreaticoduodenectomy really necessary? Langenbecks Arch Surg, 2018, 403(5): 573-580.
2.	Nelson R, Edwards S, Tse B. Prophylactic nasogastric decom-pression after abdominal surgery. Cochrane Database Syst Rev, 2007, (3): CD004929.
3.	汤庆峰, 戴德祥, 王绍勇, 等. 腹腔镜胆总管探查取石术的临床体会. 中国普外基础与临床杂志, 2010, 17(12): 1302-1304.
4.	Chen KT, Wu VC, Wu KD, et al. Is prophylactic nasogastric tube decompression necessary in patients undergoing laparoscopic adrenalectomy for unilateral benign adrenal tumor. J Formos Med Assoc, 2019, 118(1 Pt 3): 401-405.
5.	Rahbari NN, Garden OJ, Padbury R, et al. Post-hepatectomy haemorrhage: a definition and grading by the International Study Group of Liver Surgery (ISGLS). HPB (Oxford), 2011, 13(8): 528-535.
6.	Koch M, Garden OJ, Padbury R, et al. Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery, 2011, 149(5): 680-688.
7.	Ogasawara S, Chiba T, Ooka Y, et al. A randomized placebo-controlled trial of prophylactic dexamethasone for transcatheter arterial chemoembolization. Hepatology, 2017 Jul 26. doi: 10.1002/hep.29403.
8.	European Association for the Study of the Liver (EASL). Electronic address: easloffice@easloffice.eu. EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones. J Hepatol, 2016, 65(1): 146-181.
9.	Ricci C, Pagano N, Taffurelli G, et al. Comparison of efficacy and safety of 4 combinations of laparoscopic and intraoperative techniques for management of gallstone disease with biliary duct calculi: a systematic review and network meta-analysis. JAMA Surg, 2018, 153(7): e181167.
10.	Li T, Wen J, Bie L, et al. Comparison of the long-term outcomes of endoscopic papillary large balloon dilation alone versus endoscopic sphincterotomy for removal of bile duct stones. Gastroenterol Res Pract, 2018, 2018: 6430701.
11.	Lu Y, Wu JC, Liu L, et al. Short-term and long-term outcomes after endoscopic sphincterotomy versus endoscopic papillary balloon dilation for bile duct stones. Eur J Gastroenterol Hepatol, 2014, 26(12): 1367-1373.
12.	Guan G, Sun C, Ren Y, et al. Comparing a single-staged laparoscopic cholecystectomy with common bile duct exploration versus a two-staged endoscopic sphincterotomy followed by laparoscopic cholecystectomy. Surgery, 2018, 164(5): 1030-1034.
13.	Pan L, Chen M, Ji L, et al. The safety and efficacy of laparoscopic common bile duct exploration combined with cholecystectomy for the management of cholecysto-choledocholithiasis: an up-to-date meta-analysis. Ann Surg, 2018, 268(2): 247-253.
14.	Singh AN, Kilambi R. Single-stage laparoscopic common bile duct exploration and cholecystectomy versus two-stage endoscopic stone extraction followed by laparoscopic cholecystectomy for patients with gallbladder stones with common bile duct stones: systematic review and meta-analysis of randomized trials with trial sequential analysis. Surg Endosc, 2018, 32(9): 3763-3776.
15.	Rao W, Zhang X, Zhang J, et al. The role of nasogastric tube in decompression after elective colon and rectum surgery: a meta-analysis. Int J Colorectal Dis, 2011, 26(4): 423-429.
16.	Wei ZW, Li JL, Li ZS, et al. Systematic review of nasogastric or nasojejunal decompression after gastrectomy for gastric cancer. Eur J Surg Oncol, 2014, 40(12): 1763-1770.
17.	Weijs TJ, Kumagai K, Berkelmans GH, et al. Nasogastric decompression following esophagectomy: a systematic literature review and meta-analysis. Dis Esophagus, 2017, 30(3): 1-8.
18.	Hoffmann S, Koller M, Plaul U, et al. Nasogastric tube versus gastrostomy tube for gastric decompression in abdominal surgery: a prospective, randomized trial comparing patients’ tube-related inconvenience. Langenbecks Arch Surg, 2001, 386(6): 402-409.
19.	Zhang HW, Sun L, Yang XW, et al. Safety of total gastrectomy without nasogastric and nutritional intubation. Mol Clin Oncol, 2017, 7(3): 421-426.
20.	Wang D, Li T, Yu J, et al. Is nasogastric or nasojejunal decom-pression necessary following gastrectomy for gastric cancer? A systematic review and meta-analysis of randomised controlled trials. J Gastrointest Surg, 2015, 19(1): 195-204.
21.	Bisch SP, Wells T, Gramlich L, et al. Enhanced Recovery After Surgery (ERAS) in gynecologic oncology: System-wide implementation and audit leads to improved value and patient outcomes. Gynecol Oncol, 2018, 151(1): 117-123.
22.	Yilmaz G, Akça A, Aydin N. Enhanced recovery after surgery (ERAS) versus conventional postoperative care in patients undergoing abdominal hysterectomies. Ginekol Pol, 2018, 89(7): 351-356.
23.	张心怡, 熊先泽, 程南生. 快速康复外科应用于肝胆管结石的现状及展望. 中国普外基础与临床杂志, 2018, 25(3): 372-378.
24.	Zhao W, Ge C, Zhang W, et al. The important role of positioning in nasogastric tube insertion in unconscious patients: A prospective, randomised, double-blind study. J Clin Nurs, 2018, 27(1-2): e162-e168.
25.	Gillesby WJ. Gastrointestinal decompression in reconstructive bowel and biliary surgery. Surg Clin North Am, 1962, 2: 231-239.
26.	Gao Y, Zhou S, Jiang W, et al. Effects of ganopoly (a Ganoderma lucidum polysaccharide extract) on the immune functions in advanced-stage cancer patients. Immunol Invest, 2003, 32(3): 201-215.
27.	Suzana S, Boon PC, Chan PP, et al. Malnutrition risk and its association with appetite, functional and psychosocial status among elderly Malays in an agricultural settlement. Malays J Nutr, 2013, 19(1): 65-75.
28.	Lavi R, Katznelson R, Cheng D, et al. The effect of nasogastric tube application during cardiac surgery on postoperative nausea and vomiting-a randomized trial. J Cardiothorac Vasc Anesth, 2011, 25(1): 105-109.

1. Gaignard E, Bergeat D, Courtin-Tanguy L, et al. Is systematic nasogastric decompression after pancreaticoduodenectomy really necessary? Langenbecks Arch Surg, 2018, 403(5): 573-580.
2. Nelson R, Edwards S, Tse B. Prophylactic nasogastric decom-pression after abdominal surgery. Cochrane Database Syst Rev, 2007, (3): CD004929.
3. 汤庆峰, 戴德祥, 王绍勇, 等. 腹腔镜胆总管探查取石术的临床体会. 中国普外基础与临床杂志, 2010, 17(12): 1302-1304.
4. Chen KT, Wu VC, Wu KD, et al. Is prophylactic nasogastric tube decompression necessary in patients undergoing laparoscopic adrenalectomy for unilateral benign adrenal tumor. J Formos Med Assoc, 2019, 118(1 Pt 3): 401-405.
5. Rahbari NN, Garden OJ, Padbury R, et al. Post-hepatectomy haemorrhage: a definition and grading by the International Study Group of Liver Surgery (ISGLS). HPB (Oxford), 2011, 13(8): 528-535.
6. Koch M, Garden OJ, Padbury R, et al. Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery, 2011, 149(5): 680-688.
7. Ogasawara S, Chiba T, Ooka Y, et al. A randomized placebo-controlled trial of prophylactic dexamethasone for transcatheter arterial chemoembolization. Hepatology, 2017 Jul 26. doi: 10.1002/hep.29403.
8. European Association for the Study of the Liver (EASL). Electronic address: easloffice@easloffice.eu. EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones. J Hepatol, 2016, 65(1): 146-181.
9. Ricci C, Pagano N, Taffurelli G, et al. Comparison of efficacy and safety of 4 combinations of laparoscopic and intraoperative techniques for management of gallstone disease with biliary duct calculi: a systematic review and network meta-analysis. JAMA Surg, 2018, 153(7): e181167.
10. Li T, Wen J, Bie L, et al. Comparison of the long-term outcomes of endoscopic papillary large balloon dilation alone versus endoscopic sphincterotomy for removal of bile duct stones. Gastroenterol Res Pract, 2018, 2018: 6430701.
11. Lu Y, Wu JC, Liu L, et al. Short-term and long-term outcomes after endoscopic sphincterotomy versus endoscopic papillary balloon dilation for bile duct stones. Eur J Gastroenterol Hepatol, 2014, 26(12): 1367-1373.
12. Guan G, Sun C, Ren Y, et al. Comparing a single-staged laparoscopic cholecystectomy with common bile duct exploration versus a two-staged endoscopic sphincterotomy followed by laparoscopic cholecystectomy. Surgery, 2018, 164(5): 1030-1034.
13. Pan L, Chen M, Ji L, et al. The safety and efficacy of laparoscopic common bile duct exploration combined with cholecystectomy for the management of cholecysto-choledocholithiasis: an up-to-date meta-analysis. Ann Surg, 2018, 268(2): 247-253.
14. Singh AN, Kilambi R. Single-stage laparoscopic common bile duct exploration and cholecystectomy versus two-stage endoscopic stone extraction followed by laparoscopic cholecystectomy for patients with gallbladder stones with common bile duct stones: systematic review and meta-analysis of randomized trials with trial sequential analysis. Surg Endosc, 2018, 32(9): 3763-3776.
15. Rao W, Zhang X, Zhang J, et al. The role of nasogastric tube in decompression after elective colon and rectum surgery: a meta-analysis. Int J Colorectal Dis, 2011, 26(4): 423-429.
16. Wei ZW, Li JL, Li ZS, et al. Systematic review of nasogastric or nasojejunal decompression after gastrectomy for gastric cancer. Eur J Surg Oncol, 2014, 40(12): 1763-1770.
17. Weijs TJ, Kumagai K, Berkelmans GH, et al. Nasogastric decompression following esophagectomy: a systematic literature review and meta-analysis. Dis Esophagus, 2017, 30(3): 1-8.
18. Hoffmann S, Koller M, Plaul U, et al. Nasogastric tube versus gastrostomy tube for gastric decompression in abdominal surgery: a prospective, randomized trial comparing patients’ tube-related inconvenience. Langenbecks Arch Surg, 2001, 386(6): 402-409.
19. Zhang HW, Sun L, Yang XW, et al. Safety of total gastrectomy without nasogastric and nutritional intubation. Mol Clin Oncol, 2017, 7(3): 421-426.
20. Wang D, Li T, Yu J, et al. Is nasogastric or nasojejunal decom-pression necessary following gastrectomy for gastric cancer? A systematic review and meta-analysis of randomised controlled trials. J Gastrointest Surg, 2015, 19(1): 195-204.
21. Bisch SP, Wells T, Gramlich L, et al. Enhanced Recovery After Surgery (ERAS) in gynecologic oncology: System-wide implementation and audit leads to improved value and patient outcomes. Gynecol Oncol, 2018, 151(1): 117-123.
22. Yilmaz G, Akça A, Aydin N. Enhanced recovery after surgery (ERAS) versus conventional postoperative care in patients undergoing abdominal hysterectomies. Ginekol Pol, 2018, 89(7): 351-356.
23. 张心怡, 熊先泽, 程南生. 快速康复外科应用于肝胆管结石的现状及展望. 中国普外基础与临床杂志, 2018, 25(3): 372-378.
24. Zhao W, Ge C, Zhang W, et al. The important role of positioning in nasogastric tube insertion in unconscious patients: A prospective, randomised, double-blind study. J Clin Nurs, 2018, 27(1-2): e162-e168.
25. Gillesby WJ. Gastrointestinal decompression in reconstructive bowel and biliary surgery. Surg Clin North Am, 1962, 2: 231-239.
26. Gao Y, Zhou S, Jiang W, et al. Effects of ganopoly (a Ganoderma lucidum polysaccharide extract) on the immune functions in advanced-stage cancer patients. Immunol Invest, 2003, 32(3): 201-215.
27. Suzana S, Boon PC, Chan PP, et al. Malnutrition risk and its association with appetite, functional and psychosocial status among elderly Malays in an agricultural settlement. Malays J Nutr, 2013, 19(1): 65-75.
28. Lavi R, Katznelson R, Cheng D, et al. The effect of nasogastric tube application during cardiac surgery on postoperative nausea and vomiting-a randomized trial. J Cardiothorac Vasc Anesth, 2011, 25(1): 105-109.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Is prophylactic gastrointestinal decompression necessary in patients undergoing laparoscopic common bile duct exploration?

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