Comparison of Patient Outcomes and Safety between Overlapping and Nonoverlapping Surgeries in Patients Undergoing Laparoscopic Common Bile Duct Exploration

Abstract

Purpose

Overlapping surgery or double-booking is a vital yet disputed issue in healthcare field. However, safety of the overlapping surgery during laparoscopic common bile duct exploration (LCBDE) remains unclear. This study aimed to assess the clinical outcomes and safety of overlapping surgery during laparoscopic cholecystectomy and LCBDE for gallbladder and common bile duct stones (CBDS).

Material and Methods

This study retrospectively reviewed 2736 laparoscopic cholecystectomy and LCBDE surgeries during 2013–2020. One thousand, two hundred eighty patients underwent LCBDE through cystic duct, including 867 receiving overlapping procedures, while 1456 underwent LCBDE through laparoscopic choledochotomy (LC), including 981 who underwent overlapping procedures. Data regarding patient sex, age, body mass index, the American Society of Anesthesiology grade, comorbidities, preoperative liver function test, previous upper abdominal surgery, presence of acute cholecystitis, cholangitis, pancreatitis, or jaundice, common bile duct (CBD) or CBDS diameter, CBDS number, LCBDE operation time, procedure duration, length of stay, stone clearance, CBD closure methods, conversion to open surgery, and complications were collected.

Results

Differences in demographics and clinical variables between both groups were not significant, and the unadjusted outcomes were comparable, except for the total procedure duration (transcystic: p < .001; LC: p < .001). After adjusting for demographics and clinical variables, overlapping surgery showed an extended total surgical procedure duration (transcystic: standardized coefficient = 0.084, p = .004; LC: standardized coefficient = 0.072, p = .015). Other effects of overlapping surgery were also comparable.

Conclusions

Overlapping surgery in laparoscopic cholecystectomy and LCBDE was safe at our institution. However, the association of patient outcomes with overlapping laparoscopic cholecystectomy and LCBDE should be further investigated.

Keywords:

• common bile duct stone
• cholecystectomy
• gallbladder stone
• laparoscopic common bile duct exploration
• overlapping surgery

Acknowledgment

Our thanks should go to all the staff for their assistance and suggestions on the present work.

Disclosure statement

The authors report no conflict of interest, financial or otherwise.

An ethics statement

The study design was approved by the Medical Ethics Committee of the Lu 'an Hospital Affiliated to Anhui Medical University (Approval Number 2020YJ054) and informed consent was obtained from all participants.

Additional information

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.