Conversion to open surgery during laparoscopic common bile duct exploration: predictive factors and impact on the perioperative outcomes,HPB

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Conversion to open surgery during laparoscopic common bile duct exploration: predictive factors and impact on the perioperative outcomes
HPB ( IF 2.7 ) Pub Date : 2021-06-08 , DOI: 10.1016/j.hpb.2021.05.009
Carmen Payá-Llorente ₁ , Carlos Domingo-Del Pozo ₁ , Paula Gonzálvez-Guardiola ₁ , Sandra Santarrufina-Martínez ₁ , Eugenia Pareja-Ibars ₁ , Aleix Martínez-Pérez ₂

Affiliation

Background

Laparoscopic common bile duct exploration (LCBDE) is an effective treatment for choledocholithiasis. The aim of this study was to determine the predictive factors associated with conversion during LCBDE and to assess the implications of conversion on the patients’ postoperative course.

Methods

A retrospective cohort study based on patients undergoing LCBDE between 2000 and 2018 was conducted. Uni- and multivariate regression analyses were performed.

Results

A total of 357 patients underwent LCBDE, and the conversion rate was 14.2%. The main reasons for conversion were lithiasis extraction (21; 41%) and difficult dissection (13; 26%). Independent predictors for conversion were increasing levels of serum bilirubin prior to surgery (OR=4.745, 95% CI: 1.390-16.198; p=0.013), and emergency setting (OR=4.144, 95% CI: 1.449-11.846; p=0.008). Age was independently associated with lower odds of conversion (OR=0.979, 95% CI: 0.960-0.999; p=0.036). Conversion had a negative impact on the patients’ postoperative course, including severe complication (21.6% vs. 5.2% p<0.001) and surgical reintervention (11.8% vs. 2.6% p=0.002) rates.

Conclusion

Conversion to open surgery during LCBDE was associated with increased postoperative morbidity. Emergency surgery and increasing levels of serum bilirubin previous to surgery independently increase the probability of conversion; however age was independently associated with lower odds of conversion.

中文翻译：

腹腔镜胆总管探查中转开放手术：预测因素及对围手术期结局的影响

背景

腹腔镜胆总管探查术（LCBDE）是治疗胆总管结石的有效方法。本研究的目的是确定与 LCBDE 期间转换相关的预测因素，并评估转换对患者术后病程的影响。

方法

对 2000 年至 2018 年间接受 LCBDE 的患者进行了一项回顾性队列研究。进行了单变量和多变量回归分析。

结果

共有357例患者接受了LCBDE，转化率为14.2%。转换的主要原因是结石提取 (21; 41%) 和解剖困难 (13; 26%)。转化的独立预测因素是手术前血清胆红素水平升高（OR=4.745，95% CI：1.390-16.198；p=0.013）和紧急情况（OR=4.144，95% CI：1.449-11.846；p=0.008））。年龄与较低的转化几率独立相关（OR=0.979，95% CI：0.960-0.999；p=0.036）。转换对患者的术后病程有负面影响，包括严重并发症（21.6% vs. 5.2% p<0.001）和手术再干预（11.8% vs. 2.6% p=0.002）率。