Objective To evaluate safety, efficacy, and indications of laparoscopic bile duct reexploration in treatment of bile duct stones. Methods Fifty-seven patients with bile duct stones who underwent laparoscopic common bile duct reexploration (laparoscope group) and 62 patients with bile duct stones who underwent open common bile duct reexploration (laparotomy group) were included into this study from February 2013 to February 2017 in the Renmin Hospital of Wuhan University. The intraoperative and postoperative data of the patients were documented and analyzed. Results All the operations were performed successfully and all the patients had no extra-damage during the operation. One case was converted to the laparotomy due to the intraabdominal serious adhesion in the laparoscope group. Compared with the laparotomy group, the amount of intraoperative blood loss was less, the first time of anal exhaust was earlier, the rates of postoperative analgesia and incision infection were lower, and the length of hospital stay was shorter in the laparoscope group, there were significant differences (P<0.05). There were no significant differences in the operative time, the hospitalization expense, primary suture rate of common bile duct, and the rates of postoperative complications such as the bile leakage, bile duct stricture, and residual stone between the laparoscope group and the laparotomy group (P>0.05). Conclusion With experienced skills and strict surgical indications, laparoscopic common bile duct reexploration is safe and effective in treatment of bile duct stones, and it has some advantages including less bleeding, rapid recovery, and shorter hospitalization time.
ObjectiveThis meta-analysis aimed to systematically evaluate the feasibility and the safety of total laparoscopic pancreatoduodenectomy (TLPD) by comparing it with open pancreatoduodenectomy (OPD).MethodsWe searched the relative domestic and international data bases systematically, such as the Cochrane Library, Medline Database, SCI, CBM, VIP-data, CNKI-data, and WanFang Data. We selected case control studies or cohort studies, and used the Review Manager 5.3 to perform statistical analysis.ResultsIn total, thirteen single-center retrospective case-control studies were included, totally 808 patients involved, and there were 401 cases in the TLPD group and 407 cases in the OPD group. There were no significant difference in terms of the cumulative morbidity, incidence of the Clavien Ⅲ-Ⅴ complication, pancreatic fistula, B/C pancreatic fistula, biliary fistula, postoperative hemorrhage, pulmonary infection, and gastric emptying delay, as well as the ratio of secondary operation, mortality of perioperative period, the ration of R0 resection, and the number of lymph nodes dissected between the 2 groups (P>0.05). Although the operative time was significant longer, TLPD had significant superiority in terms of the amount of bleeding and blood transfusion during operation, the hospital stays after operation, the bowel function recovery time, the time to restart eating, and the time to reactivate (P<0.05).ConclusionIn terms of the relative complications and the parameters of oncology such as the ration of R0 resection, the number of lymph nodes dissected, both of the procedures are safe and feasible, while TLPD is more favorable to control operative bleeding and accelerate rehabilitation.