Effect of preoperative jaundice on complications of laparoscopic cholecystectomy combined with intraoperative biliary stone removal in patients with common bile duct stones_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

HAN Hui ¹ ,  ZHENG Kang ²

1. Department of General Surgery, Baishui County Hospital, Baishui, Shaanxi 715600, P. R. China;
2. Department of General Surgery, No.215 Hospital of Shaanxi Nuclear Industry, Xianyang, Shaanxi 712000, P. R. China;

Corresponding author：

ZHENG Kang, Email: zhengk1355@163.com

Keywords：

common bile duct stone; jaundice; emergency surgery; laparoscopic cholecystectomy

DOI：

10.7507/1007-9424.201903014

Video：

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Objective To explore the effect of preoperative jaundice on the complications of laparoscopic cholecystectomy combined with intraoperative biliary stone removal in patients with common bile duct stones.Methods A total of 104 patients with choledocholithiasis who underwent laparoscopic cholecystectomy combined with intraoperative biliary stone removal for common bile duct stones in Baishui County Hospital and No.215 Hospital of Shaanxi Nuclear Industry between January 2014 and February 2016 were enrolled and retrospectively analyzed. The patients were divided into the jaundice group (43 cases) and the jaundice-free control group (control group, 61 cases) according to the preoperative serum total bilirubin level. The differences in postoperative complication rates between the two groups were compared and risk factors affecting postoperative complications were explored.Results The ALT and total bilirubin on the first day after operation in the jaundice group were higher than those in the control group (P<0.05). In addition, the hospital stay in the jaundice group was shorter than that of the control group (P<0.001). There was no significant difference in the incidence of total postoperative complication rate and the incidence of complications (included biliary leakage, ballistic hemorrhage, hyperthermia, incision complications, and other complications) between the two groups (P>0.05). There were no significant differences in Clavien-Dindo classification, comprehensive complication index (CCI), and ratio of CCI≥20 (P>0.05). Multivariate analysis showed that male and residual stones were independently associated with postoperative complications (P<0.05), but there was no statistical correlation between preoperative jaundice and postoperative complications (P>0.05).Conclusion Preoperative jaundice does not increase the risk of complications after acute laparoscopic surgery in patients with common bile duct stones.

Citation： HAN Hui, ZHENG Kang. Effect of preoperative jaundice on complications of laparoscopic cholecystectomy combined with intraoperative biliary stone removal in patients with common bile duct stones. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(7): 828-833. doi: 10.7507/1007-9424.201903014 Copy

1.	Williams E, Beckingham I, El Sayed G, et al. Updated guideline on the management of common bile duct stones (CBDS). Gut, 2017, 66(5): 765-782.
2.	Li YL, Wong KH, Chiu KW, et al. Percutaneous cholecystostomy for high-risk patients with acute cholangitis. Medicine (Baltimore), 2018, 97(19): e0735.
3.	Kuzu UB, Ödemiş B, Dişibeyaz S, et al. Management of suspected common bile duct stone: diagnostic yield of current guidelines. HPB (Oxford), 2017, 19(2): 126-132.
4.	郑楚发, 王小忠, 黄耀奎, 等. 腹腔镜胆总管探查术治疗胆总管结石. 中华肝胆外科杂志, 2016, 22(6): 378-381.
5.	王帅, 邱远, 江恩来, 等. 从手术应激的角度看加速康复外科. 中国普外基础与临床杂志, 2018, 25(7): 878-882.
6.	Hussameddin AM, AlFawaz II, AlOtaibi RF. Common bile duct stone formed around a migrated clip: an unexpected complication of laparoscopic cholecystectomy. Case Rep Gastrointest Med, 2018, 2018: 5892143.
7.	Philip Rothman J, Burcharth J, Pommergaard HC, et al. Preoperative risk factors for conversion of laparoscopic cholecystectomy to open surgery-a systematic review and meta-analysis of observational studies. Dig Surg, 2016, 33(5): 414-423.
8.	Hu ASY, Menon R, Gunnarsson R, et al. Risk factors for conversion of laparoscopic cholecystectomy to open surgery-a systematic literature review of 30 studies. Am J Surg, 2017, 214(5): 920-930.
9.	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.
10.	Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg, 2009, 250(2): 187-196.
11.	Slankamenac K, Nederlof N, Pessaux P, et al. The comprehensive complication index: a novel and more sensitive endpoint for assessing outcome and reducing sample size in randomized controlled trials. Ann Surg, 2014, 260(5): 757-762.
12.	Pavlidis ET, Pavlidis TE. Pathophysiological consequences of obstructive jaundice and perioperative management. Hepatobiliary Pancreat Dis Int, 2018, 17(1): 17-21.
13.	Gordillo Hernández A, Nogales Muñoz Á, Oliva Mompeán F. Unusual presentation of obstructive jaundice. Rev Esp Enferm Dig, 2017, 109(3): 238-239.
14.	Gupta V, Makharia G. Von Meyenburg complexes in a patient with obstructive jaundice. Med J Aust, 2017, 207(6): 239.
15.	邹晓明, 云哲琳, 张生彬, 等. 胰十二指肠切除术后并发症的Clavien-Dindo分级及危险因素分析. 中华消化外科杂志, 2016, 15(6): 579-583.
16.	Zhu F, Feng D, Zhang T, et al. Toward a more sensitive endpoint for assessing postoperative complications in patients with inflammatory bowel disease: a comparison between comprehensive complication index (CCI) and Clavien-Dindo classification (CDC). J Gastrointest Surg, 2018, 22(9): 1593-1602.
17.	Doi A, Morimoto T, Iwata K. Shorter duration of antibiotic treatment for acute bacteraemic cholangitis with successful biliary drainage: a retrospective cohort study. Clin Microbiol Infect, 2018, 24(11): 1184-1189.
18.	Miura F, Okamoto K, Takada T, et al. Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis. J Hepatobiliary Pancreat Sci, 2018, 25(1): 31-40.
19.	Coutinho LMA, Bernardo WM, Rocha RS, et al. Early endoscopic retrograde cholangiopancreatography versus conservative treatment in patients with acute biliary pancreatitis: systematic review and meta-analysis of randomized controlled trials. Pancreas, 2018, 47(4): 444-453.
20.	Kim MS, Jeon TJ, Park JY, et al. Clinical interpretation of elevated CA 19-9 levels in obstructive jaundice following benign and malignant pancreatobiliary disease. Korean J Gastroenterol, 2017, 70(2): 96-102.
21.	Duan F, Cui L, Bai Y, et al. Comparison of efficacy and complications of endoscopic and percutaneous biliary drainage in malignant obstructive jaundice: a systematic review and meta-analysis. Cancer Imaging, 2017, 17(1): 27.
22.	陈晓鹏, 王东, 崔巍, 等. 加速康复外科联合腹腔镜胆总管探查术治疗胆总管结石的前瞻性研究. 中华消化外科杂志, 2015, 14(1): 47-51.
23.	Poh BR, Ho SP, Sritharan M, et al. Randomized clinical trial of intraoperative endoscopic retrograde cholangiopancreatography versus laparoscopic bile duct exploration in patients with choledocholithiasis. Br J Surg, 2016, 103(9): 1117-1124.
24.	Noble H, Whitley E, Norton S, et al. A study of preoperative factors associated with a poor outcome following laparoscopic bile duct exploration. Surg Endosc, 2011, 25(1): 130-139.
25.	Donkervoort SC, van Ruler O, Dijksman LM, et al. Identification of risk factors for an unfavorable laparoscopic cholecystectomy course after endoscopic retrograde cholangiography in the treatment of choledocholithiasis. Surg Endosc, 2010, 24(4): 798-804.

1. Williams E, Beckingham I, El Sayed G, et al. Updated guideline on the management of common bile duct stones (CBDS). Gut, 2017, 66(5): 765-782.
2. Li YL, Wong KH, Chiu KW, et al. Percutaneous cholecystostomy for high-risk patients with acute cholangitis. Medicine (Baltimore), 2018, 97(19): e0735.
3. Kuzu UB, Ödemiş B, Dişibeyaz S, et al. Management of suspected common bile duct stone: diagnostic yield of current guidelines. HPB (Oxford), 2017, 19(2): 126-132.
4. 郑楚发, 王小忠, 黄耀奎, 等. 腹腔镜胆总管探查术治疗胆总管结石. 中华肝胆外科杂志, 2016, 22(6): 378-381.
5. 王帅, 邱远, 江恩来, 等. 从手术应激的角度看加速康复外科. 中国普外基础与临床杂志, 2018, 25(7): 878-882.
6. Hussameddin AM, AlFawaz II, AlOtaibi RF. Common bile duct stone formed around a migrated clip: an unexpected complication of laparoscopic cholecystectomy. Case Rep Gastrointest Med, 2018, 2018: 5892143.
7. Philip Rothman J, Burcharth J, Pommergaard HC, et al. Preoperative risk factors for conversion of laparoscopic cholecystectomy to open surgery-a systematic review and meta-analysis of observational studies. Dig Surg, 2016, 33(5): 414-423.
8. Hu ASY, Menon R, Gunnarsson R, et al. Risk factors for conversion of laparoscopic cholecystectomy to open surgery-a systematic literature review of 30 studies. Am J Surg, 2017, 214(5): 920-930.
9. 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.
10. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg, 2009, 250(2): 187-196.
11. Slankamenac K, Nederlof N, Pessaux P, et al. The comprehensive complication index: a novel and more sensitive endpoint for assessing outcome and reducing sample size in randomized controlled trials. Ann Surg, 2014, 260(5): 757-762.
12. Pavlidis ET, Pavlidis TE. Pathophysiological consequences of obstructive jaundice and perioperative management. Hepatobiliary Pancreat Dis Int, 2018, 17(1): 17-21.
13. Gordillo Hernández A, Nogales Muñoz Á, Oliva Mompeán F. Unusual presentation of obstructive jaundice. Rev Esp Enferm Dig, 2017, 109(3): 238-239.
14. Gupta V, Makharia G. Von Meyenburg complexes in a patient with obstructive jaundice. Med J Aust, 2017, 207(6): 239.
15. 邹晓明, 云哲琳, 张生彬, 等. 胰十二指肠切除术后并发症的Clavien-Dindo分级及危险因素分析. 中华消化外科杂志, 2016, 15(6): 579-583.
16. Zhu F, Feng D, Zhang T, et al. Toward a more sensitive endpoint for assessing postoperative complications in patients with inflammatory bowel disease: a comparison between comprehensive complication index (CCI) and Clavien-Dindo classification (CDC). J Gastrointest Surg, 2018, 22(9): 1593-1602.
17. Doi A, Morimoto T, Iwata K. Shorter duration of antibiotic treatment for acute bacteraemic cholangitis with successful biliary drainage: a retrospective cohort study. Clin Microbiol Infect, 2018, 24(11): 1184-1189.
18. Miura F, Okamoto K, Takada T, et al. Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis. J Hepatobiliary Pancreat Sci, 2018, 25(1): 31-40.
19. Coutinho LMA, Bernardo WM, Rocha RS, et al. Early endoscopic retrograde cholangiopancreatography versus conservative treatment in patients with acute biliary pancreatitis: systematic review and meta-analysis of randomized controlled trials. Pancreas, 2018, 47(4): 444-453.
20. Kim MS, Jeon TJ, Park JY, et al. Clinical interpretation of elevated CA 19-9 levels in obstructive jaundice following benign and malignant pancreatobiliary disease. Korean J Gastroenterol, 2017, 70(2): 96-102.
21. Duan F, Cui L, Bai Y, et al. Comparison of efficacy and complications of endoscopic and percutaneous biliary drainage in malignant obstructive jaundice: a systematic review and meta-analysis. Cancer Imaging, 2017, 17(1): 27.
22. 陈晓鹏, 王东, 崔巍, 等. 加速康复外科联合腹腔镜胆总管探查术治疗胆总管结石的前瞻性研究. 中华消化外科杂志, 2015, 14(1): 47-51.
23. Poh BR, Ho SP, Sritharan M, et al. Randomized clinical trial of intraoperative endoscopic retrograde cholangiopancreatography versus laparoscopic bile duct exploration in patients with choledocholithiasis. Br J Surg, 2016, 103(9): 1117-1124.
24. Noble H, Whitley E, Norton S, et al. A study of preoperative factors associated with a poor outcome following laparoscopic bile duct exploration. Surg Endosc, 2011, 25(1): 130-139.
25. Donkervoort SC, van Ruler O, Dijksman LM, et al. Identification of risk factors for an unfavorable laparoscopic cholecystectomy course after endoscopic retrograde cholangiography in the treatment of choledocholithiasis. Surg Endosc, 2010, 24(4): 798-804.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Effect of preoperative jaundice on complications of laparoscopic cholecystectomy combined with intraoperative biliary stone removal in patients with common bile duct stones

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