Background and aim

Surgical management by a bilioenteric anastomosis is the standard for the repair of post-cholecystectomy benign biliary strictures (BBS). This is traditionally done as an open operation. There are a few reports describing the procedure by a laparoscopic technique. The aim of the present study was to describe our experience of laparoscopic bilio-enteric anastomosis [Roux-en-Y hepaticojejunostomy (LRYHJ)/laparoscopic hepaticoduodenostomy (LHD)] in the management of post-cholecystectomy BBS and compare the outcomes with our patients operated by the open approach.

Methods

Retrospective analysis of prospective data of post-cholecystectomy BBS patients treated by laparoscopic bilio-enteric anastomosis. The outcomes were compared with patients who underwent an open repair.

Results

Between January 2016 and February 2019, 63 patients underwent surgery for post-cholecystectomy BBS. Twenty-nine patients who underwent laparoscopic bilio-enteric anastomosis (LRYHJ-13, LHD-16) were compared with 34 patients who underwent an open repair. The median age (40 vs 39) years, type of index surgery [laparoscopic cholecystectomy (13 vs 15), laparoscopic converted to open cholecystectomy (10 vs 16), and open cholecystectomy (6 vs 3)], type of injury low stricture (7 vs 5) and high stricture (22 vs 29), preoperative biliary fistula (23 vs 30), and time from injury to repair (6 vs 7 months) were similar in the 2 groups. The median duration of surgery was also similar (210 vs 200 min, p = 0.937); however, the median intraoperative blood loss (50 mL vs 200 mL, p = 0.001), time to resume oral diet (2 vs 4 days p = 0.023),** and median duration of postoperative hospital stay (6 vs 8 days, p = 0.001) were significantly less in the laparoscopy group. Overall morbidity rate (within 30 days post-surgery) was significantly higher in the open repair group (38% vs 20%). In a subgroup analysis of the laparoscopic repair group, the operative time in patients who underwent an LHD was significantly less than LRYHJ (190 vs 230 min, p = 0.034). The other parameters like the mean intraoperative blood loss, time to initiate oral diet, duration of postoperative hospital stay, and incidence of postoperative bile leak were similar. Patients undergoing open repair had a median follow-up of 26 months with two developing anastomotic stenosis and those undergoing laparoscopic repair had a median follow-up for 9 months with one developing anastomotic stenosis.

Conclusion

Laparoscopic surgery for post-cholecystectomy BBS with an LRYHJ or LHD is feasible and safe and compares favourably with the open approach.

中文翻译：

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腹腔镜与开腹手术治疗胆囊切除术后良性胆管狭窄

背景和目标

胆肠吻合术的外科手术处理是修复胆囊切除术后良性胆管狭窄（BBS）的标准。传统上，这是作为开放操作完成的。有一些报道通过腹腔镜技术描述了该过程。本研究的目的是描述我们在腹腔镜胆囊切除术后BBS治疗中的腹腔镜胆囊肠吻合术[Roux-en-Y肝空肠吻合术（LRYHJ）/腹腔镜肝十二指肠吻合术（LHD）]的经验，并比较其结局。通过开放的方式。

方法

腹腔镜胆总管肠吻合术治疗胆囊切除术后BBS患者的前瞻性数据的回顾性分析。将结果与接受开放式修补的患者进行比较。

结果

在2016年1月至2019年2月之间，有63名患者接受了胆囊切除术后BBS手术。比较了29例行腹腔镜胆肠吻合术（LRYHJ-13，LHD-16）与34例行开放性修补术的患者。中位年龄（40 vs 39）岁，分期手术类型[腹腔镜胆囊切除术（13 vs 15），腹腔镜转换为开腹胆囊切除术（10 vs 16），开腹胆囊切除术（6 vs 3）]，损伤类型为低狭窄（ 7 vs 5）和高狭窄（22 vs 29），术前胆瘘（23 vs 30）以及从受伤到修复的时间（6 vs7个月）两组相似。中位手术时间也相似（210 vs 200 min，p  = 0.937）；但是，术中出血量中位数（50 mL vs 200 mL，p  = 0.001），恢复口服饮食的时间（2 vs 4天，p  = 0.023），**和术后住院时间的中位数（6 vs 8天，p  = 0.001）的腹腔镜检查组明显减少。开放修复组的总体发病率（手术后30天内）明显更高（38％对20％）。在腹腔镜修复组的亚组分析中，接受LHD的患者的手术时间明显少于LRYHJ（190vs 230分钟，p  = 0.034）。其他参数，如术中平均失血量，开始口服饮食的时间，术后住院时间和术后胆漏的发生率相似。接受开放式修复的患者中位随访26个月，其中2例发展为吻合口狭窄；接受腹腔镜修复的患者进行中位随访9个月，其中1例进展为吻合口狭窄。

结论

腹腔镜手术在胆囊切除术后使用LRYHJ或LHD进行BBS是可行和安全的，并且与开放式手术相比具有优势。