Technical difficulties of laparoscopic common bile duct exploration and their countermeasures for patients with history of upper abdominal surgery

Objective To investigate the technical difficulties of laparoscopic common bile duct exploration (LCBDE) and their countermeasures for patients with a history of upper abdominal surgery.Methods A retrospective analysis was performed on the clinical data of 72 patients with a history of upper abdominal surgery who underwent LCBDE at our hospital from January 2008 to October 2013.The intraoperative difficulties and their countermeasures were summarized and analyzed.Results Intraoperative difficulties occurred in 16 patients;severe adhesions in the abdominal cavity and operation region were found in 9 cases, difficult identification of the common bile duct in 4 cases, and difficult removal of stones in 3 cases.The operative time was 164.36 ± 19.06 min for all patients, 179.31 ± 13.25 min for patients encountering intraoperative difficulties, and 160.09 ± 18.37 min for those not encountering intraoperative difficulties;the operative time was significantly longer in patients encountering intraoperative difficulties than in those not encountering intraoperative difficulties and in all patients (t =-3.898, P =0.000;t =-2.976, P = 0.004) , but the operative time of patients not encountering intraoperative difficulties was not significantly different from that of all patients (t =- 1.278, P = 0.204) .Conclusion For patients with a history of upper abdominal surgery, LCBDE is an operation with high difficulty, high risk, and high technical requirement.In case of intraoperative difficulties, which would prolong the operative time, individualized countermeasures should be taken to ensure successful surgery.