Hamzeh M Halawani1, Hani Tamim2, Farah Khalifeh3, Aurélie Mailhac2, Ali Taher4, Jamal Hoballah1, Faek R Jamali5. 1. Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon. 2. Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon. 3. Department of Immunology and Microbiology, American University of Beirut Medical Center, Beirut, Lebanon. 4. Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon. 5. Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon. Electronic address: fj03@aub.edu.lb.
Abstract
BACKGROUND: Common bile duct exploration (CBDE) is an available option in the management of choledocholithiasis. We aimed to analyze outcomes comparing laparoscopic and open approaches to CBDE using the American College of Surgeons (ACS) NSQIP database. STUDY DESIGN: This was a retrospective cohort study of patients undergoing CBDE between 2008 and 2013, using the ACS NSQIP database. The cohort was split into 2 groups and compared based on operative approach: laparoscopic vs open CBDE. RESULTS: There were 2,635 patients who underwent CBDE during the study period, and 52% underwent an open approach. After adjusting for all confounding variables, open CBDE was associated with a statistically significant increase in mortality (adjusted odds ratio [AOR] 2.95; 95% CI 1.18 to 7.41; p = 0.02), composite morbidity (AOR 2.19; 95% CI 1.56 to 3.07; p < 0.0001), bleeding (AOR 1.86; 95% CI 1.11 to 3.12; p = 0.02), return to the operation room (AOR 1.90; 95% CI 1.16 to 3.12; p = 0.01), and readmission related to the first operation (AOR 1.55; 95% CI 1.00 to 2.39; p = 0.05). On the other hand, retained common bile duct stones were 2.8 times more likely to occur in the laparoscopic group. The mean operative time was longer by 73 minutes for patients who underwent open CBDE. CONCLUSIONS: Patients undergoing open CBDE suffer from a statistically significantly higher rate of mortality and overall complications compared with patients undergoing the laparoscopic approach. Laparoscopic CBDE should be considered as the preferred procedure whenever possible.
BACKGROUND: Common bile duct exploration (CBDE) is an available option in the management of choledocholithiasis. We aimed to analyze outcomes comparing laparoscopic and open approaches to CBDE using the American College of Surgeons (ACS) NSQIP database. STUDY DESIGN: This was a retrospective cohort study of patients undergoing CBDE between 2008 and 2013, using the ACS NSQIP database. The cohort was split into 2 groups and compared based on operative approach: laparoscopic vs open CBDE. RESULTS: There were 2,635 patients who underwent CBDE during the study period, and 52% underwent an open approach. After adjusting for all confounding variables, open CBDE was associated with a statistically significant increase in mortality (adjusted odds ratio [AOR] 2.95; 95% CI 1.18 to 7.41; p = 0.02), composite morbidity (AOR 2.19; 95% CI 1.56 to 3.07; p < 0.0001), bleeding (AOR 1.86; 95% CI 1.11 to 3.12; p = 0.02), return to the operation room (AOR 1.90; 95% CI 1.16 to 3.12; p = 0.01), and readmission related to the first operation (AOR 1.55; 95% CI 1.00 to 2.39; p = 0.05). On the other hand, retained common bile duct stones were 2.8 times more likely to occur in the laparoscopic group. The mean operative time was longer by 73 minutes for patients who underwent open CBDE. CONCLUSIONS:Patients undergoing open CBDE suffer from a statistically significantly higher rate of mortality and overall complications compared with patients undergoing the laparoscopic approach. Laparoscopic CBDE should be considered as the preferred procedure whenever possible.