Safety analysis of perioperative period of biliary laparoscopic surgery among 23 years in a single center

Objective To analyze the data of perioperative period of patients with biliary laparoscopic surgery during the 23 years of the PLA General Hospital, and to explore the safety of laparoscopic surgery in biliary surgery. Methods We retrospectively analyzed the clinical data of 11 419 consecutive patients underwent biliary laparoscopic surgery in PLA General Hospital between Apr. 1992 and Dec. 2014 according to the inclusion criteria. The data of biliary open surgery patients in the same period were selected as the control group to compare, and the postoperative complications of the two groups were analyzed. Results (1) From Apr. 1992 to Dec. 2014, 11 419 patients underwent laparoscopic surgery in the General Hospital of PLA among 23 years, and accounted for 56.33% of patients with biliary surgery. (2) In all patients, 2 patients died in the perioperative period, the mortality rate was 0.02%, 43 cases occurred complications, and the complication rate was 0.38%. The most common complications were biliary fistula, wound infection and abdominal infection. The incidence rate were 0.18%, 0.05% and 0.05%. Among the complications, 60.42% were Grade II compications and 4.17% were Grade V. (3)The most common diseases with complication after laparoscopic surgery were gallbladder benign disease and extrahepatic bile duct stones, accounted for 58.14% and 25.58%. (4) For gallbladder benign disease patients, the intraoperative bleeding volume, operation time, hospitalization days, complication rate, mortality rate of laparoscopic surgery were superior to open surgery[(15.6±26.1)ml、(1.1±0.5)h、(2.1±1.8)d、25 patients (0.22%)、1 patient (0.01%)] vs [(136.1±168.2)ml、(1.7±0.8)h、(9.8±5.4)d、25 patients (0.22%)、80 patients (4.42%)](P<0.01). For extrahepatic bile duct stones patients, the intraoperative bleeding volume, hospitalization days and complication rate of laparoscopic surgery were superior to open surgery [(44.4±46.1)ml、(5.4±5.7)h、11 patients (3.24%)] vs [(142.5±125.0)ml、(13.0±9.1)h、(9.8±5.4)d、84 patients (13.29%)] (P<0.01). Conclusions With the development of laparoscopic technology in biliary surgery, it is the most widely used in the gallbladder benign disease and extrahepatic bile duct stones, and the perioperative effect is better than that of the open surgery. Key words: Biliary surgery; Laparoscopic surgery; Open surgery; Complication