Preoperative factors predicting poor outcomes following laparoscopic choledochotomy: a multivariate analysis study.

BACKGROUND Laparoscopic surgery for common bile duct stones varies procedurally from a transcystic approach to laparoscopic choledochotomy (LC) with or without biliary drainage. However, LC is a difficult procedure with higher documented morbidity than the transcystic approach. We retrospectively investigated risk factors for adverse outcomes of LC. METHODS We used logistic regression models to assess 4 categories of adverse outcomes: overall, complications, conversion to open operation and failed surgical clearance. We calculated the area under the receiver operating characteristic curve to evaluate diagnostic accuracy. RESULTS We included 201 patients who underwent LC in our analysis. Adverse outcomes occurred in 48 (23.9%) patients, complications occurred in 43 (21.4%), retained stones were observed in 8 (4%), and conversion to laparotomy occurred in 7 (3.5%). Multivariate analysis showed that total bilirubin (BIL) and the presence of medical risk factors (MRFs) were significant predictors of adverse outcomes and complications. We calculated the probability of adverse outcomes (p) using the following formula: logit(p) = 0.977 (MRFs) + 0.014 (BIL) - 2.919. p = EXP (logit(p)) ÷ [1+EXP (logit(p))]. According to their logit(p), all patients were divided into a low-risk group (logit(p) ≤ -1.32, n = 130) and a high-risk group (logit(p) > -1.32, n = 71). Patients in the low-risk group had about a 1 in 10 chance (12 of 130) of adverse outcomes developing. Of the 71 patients in the high-risk group, 36 (50.7%) experienced adverse outcomes. CONCLUSION High BIL and the presence of MRFs could predict adverse outcomes in patients undergoing LC.