Risk factors for biliary complications after common bile duct exploration combined with primary suture

Objective To investigate the incidence of biliary complications after laparoscopic common bile duct exploration combined with primary suture in the treatment of patients with common bile duct stones and related risk factors.Methods A total of 134 patients with common bile duct stones who underwent common bile duct exploration combined with primary suture in The First People's Hospital of Xianyang from June 2013 to June 2016 were enrolled,and biliary complications were evaluated according to the Clavien- Dindo classification.A univariate analysis was performed for 13 possible factors for biliary complications after primary suture,the chi- square test was used for comparison between groups,and a multivariate logistic regression analysis was performed for the factors screened out in the univariate analysis.Results A total of 12 patients experienced biliary complications after surgery,resulting in an incidence rate of 8.96%;among these patients,8 had bile leakage,2 had residual stones in the bile duct,1 had biliary stricture,and 1 had hematobilia.According to the Clavien- Dindo classification,3 had grade I,5 had grade II,2 had grade IIIa,and 2 had IIIb diseases.The univariate analysis showed that postoperative biliary complications were associated with plasma albumin level,biliary reoperation,nasobiliary drainage,and surgeon's experience( χ~2= 4.012,4.942,4.336,and 5.975,all P < 0.05),while they were not associated with age,sex,increased bilirubin level,maximum stone diameter,number of stones,medical diseases,gallstones,surgical procedure,and suture method( all P > 0.05).The multivariate analysis showed that biliary reoperation and surgeon's experience were independent risk factors for postoperative biliary complications( χ~2= 6.448 and 6.842,both P < 0.05).Conclusion There are certain risks of biliary complications after common bile duct exploration combined with primary suture,and biliary leakage is the most common complication,especially in patients undergoing biliary reoperation and when there is a lack of experience in surgeons.