Banaras Akbar, Jiang Hongchi*, Ma Yong and Wang Jianqi
Introduction: Despite all recent developments in laparoscopic instruments and acquired experience with
laparoscopic common bile duct exploration (LCBDE) for choledocholithiasis management, there is still a risk of postoperative
bile leakage following common bile duct (CBD) primary closure. In this study we evaluate the application
value of fibrin-sealant on post-operative bile leakage after LCBDE.
Patients and Methods: We report a perspective, analysis of 85 patients who had undergone primary duct closure of
the CBD after LCBDE from January 2015 to November 2019. The study population was divided into two groups
according to whether they received fibrin-sealants covering the choledochorraphy or not, analyzed the incidence of
postoperative biliary leakage and other complications in each group.
Results: There were 85 patients in two study groups, 37 patients (43.55%) in fibrin-sealant group and 48 patients
(56.45%) in control group. The incidence of biliary leakage in fibrin-sealant group was one patient (2.70%) and had
Grade-A leakage while in control group were four patients (8.33%) two patients had Grade-A leakage and the other
two patients had Grade-B leakage. When we analyzed the effect of fibrin-sealant, it was detected that the application
of fibrin-sealant reduced the incidence of biliary leakage without any significant side effects in the fibrin sealant
group.
Conclusion: Human fibrin-sealants reduced the incidence of biliary leakage without any significant side effects in
patients who experienced CBD primary closure following LCBDE. Post-operatively, hemoglobin concentration level
was significantly more in fibrin-sealant group then that of control group. Our surgery team also confirmed that
during LCBDE hook and cut has better outcome than that of the hook and coagulation for the control of postoperative
bile leakage in patients with choledocholithiasis.
