Clinical analysis on day surgery of laparoscopic cholecystectomy and common bile duct exploration through cystic duct / 国际外科学杂志

ABSTRACT

Objective To investigate the safety and feasibility of laparoscopic common bile duct exploration through cystic duct while cholecystectomy by means of day surgery. Methods The data of69 patients who received day surgery of laparoscopic cholecystectomy and intraoperative transcystic biliary duct exploration from January 2015 to January 2018 in Beijing Friendship Hospital, Capital Medical University were analyzed. Preoperative symptoms and signs, laboratory examinations, imaging examinations, intraoperative exploration results, operation time, postoperative time, hospitalization expenses, as well as short time follow-up data were analyzed retrospectively. Results Sixty-nine cases of day surgery were iniolled.21.7％(15/69) were indicated in bile duct exploration according to medical history, and 33.3％ (23/69) simply because of abnormal blood examination which all showed elevated gamma-glutamyl transferase and 5.8％(4/69) only for positive imaging results. In the surgery, 24.6％(17/69) found bile duct stones, and 10.1％ (7/69) found sand-like stones or floccule in the biliary tract exploration, while negative exploration in 65, 2％(45/69). The operation time ranged from 41 to 169(median 111) minutes. No patient placed drainage tube in the surgery. Only 1 patient discharged at the first day after surgery because that nausea and vomiting led to a conversion to be hospitalized. The other patients discharged from the hospital in 1.4 to 8.3 (median 2.8) hours after the surgery; hospitalization costs 7 820 to 16 285 (Median 13 619) yuan. Telephone follow-up found no serious complications 3 days after operation, and1 patient complainted low grade fever 7 days after discharge due to gallbladder fossa fluid was cured by antibiotics. No residual stone was detected by ultrasound examination 3-month after surgery in follow-up cases. Conclusions As a practice of enhanced recovery after surgery concept, laparoscopic cholecystectomy and intraoperative transcystic bile duct exploration by means of day surgery is safe and feasible in experienced medical center. It could be safe when patients are strictly screened, although no effective method to predict the result of bile duct exploration by now.