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Laparoscopic versus open surgery for the management of post-cholecystectomy benign biliary strictures

机译：腹腔镜与胆囊切除术后良性胆道狭窄管理的开放手术

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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.
机译：背景与目的胆肠吻合术是胆囊切除术后良性胆道狭窄（BBS）修复的标准。传统上，这是一种开放式操作。有一些报道描述了通过腹腔镜技术进行的手术。本研究的目的是描述我们在胆囊切除术后BBS治疗中腹腔镜胆肠吻合术[肝管空肠Roux-en-Y吻合术（LRYHJ）/腹腔镜肝管十二指肠吻合术（LHD）]的经验，并将其结果与我们采用开放式手术的患者进行比较。方法回顾性分析腹腔镜胆肠吻合术治疗胆囊切除术后BBS患者的前瞻性资料。将结果与接受开放式修复的患者进行比较。结果2016年1月至2019年2月，63例患者接受了胆囊切除术后BBS手术。将29例接受腹腔镜胆肠吻合术（LRYHJ-13，LHD-16）的患者与34例接受开放式修复的患者进行比较。两组患者的中位年龄（40岁vs 39岁）、手术类型（腹腔镜胆囊切除术（13 vs 15）、腹腔镜中转开腹胆囊切除术（10 vs 16）和开腹胆囊切除术（6 vs 3）、损伤类型（低位狭窄（7 vs 5）和高位狭窄（22 vs 29）、术前胆瘘（23 vs 30）以及从损伤到修复的时间（6 vs 7个月）相似。手术时间的中位数也相似（210对200分钟，p=0.937）；然而，腹腔镜组术中出血量中位数（50毫升对200毫升，p=0.001）、恢复口服饮食时间中位数（2天对4天，p=0.023）、**和术后住院时间中位数（6天对8天，p=0.001）显著减少。开放修复组的总体发病率（术后30天内）显著高于开放修复组（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（190对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，其中两例发生吻合口狭窄，而接受腹腔镜修复的患者中位随访9个月，其中一例发生吻合口狭窄。结论腹腔镜手术治疗胆囊切除术后BBS合并LRYHJ或LHD是可行和安全的，与开放手术相比具有优势。

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