The Study Of The Feasibility Of Laparoscopic Biliary Operation With A History Of Upper Abdominal Surgery

Objective: By retrospectively analyzing the cases which have a history of upper abdominal surgery and accepted a secondary biliary operation,we study the feasibility of laparoscopic biliary operation with previous upper abdominal surgery.Then we can assess the feasibility of laparoscopic biliary operation with a history of upper abdominal surgery through safety,effectiveness and efficiency and guide subsequent clinical work.Methods: By retrospectively analyzing the clinical data of 219 cases which have a history of upper abdominal surgery and accepted a secondary biliary operation at the Department of general surgery of Beijing Friendship Hospital affiliated to Capital Medical University from January 2008 to September 2016,we choose the patients accepted laparoscopic biliary operation as the observation group and the open biliary surgery as the control group.Then we compared the average operation time,intraoperative blood loss,length of hospitalization and expenditure between the two groups.Using statistical means to test whether the two groups of data have significant difference or not.At the same time we analyzed the the probability of conversion to open surgery and the complications such as bile leakage,intestinal fistula and incisional infection after laparoscopic biliary operation with a history of upper abdominal surgery.Then we can assess the feasibility of laparoscopic biliary operation with a history of upper abdominal surgery through safety,effectiveness and efficiency and guide subsequent clinical work.Results: Laparoscopic operations had a longer operation time(124.4±57.2)min,lesser intraoperative blood loss(19.3±25.9)ml,shorter hospitalization time(7.5±4.5)d and lower total expenditure(￥ 15252.8.7±6840.1)than the open ones.The total rate of conversion to open surgery during laparoscopic biliary surgery with a previous upper abdominal surgery was 15.5%.In all 15 cases of short-term complications,13 cases were occurred in the open surgery group,2 cases in conversion group,and no one in the laparoscopic group.Conclusion: Compared with open surgery technique,the strategy of laparoscopic biliary operation had advantages of lesser intraoperative blood loss,shorter hospitalization time and lower total expenditure to a patient who needs a secondary biliary operation with a history of upper abdominal surgery.And the operation time is relative longer.By analyzing the incidence of short-term complications in the study group,the results showed that laparoscopic biliary surgery had a credible safety.In summary,laparoscopic biliary operation in patients with a history of previous upper abdominal operations can be a micro-invasive and safe procedure in hands of experienced surgeons widely used in subsequent clinical work.