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World journal of Minimal Access Surgery Volume No 9

Original Article Open Access

Fibrin Sealants, A Tool to Reduce Biliary Fistula After Laparoscopic Exploration of Bile Duct.

Martin Arnau Belén, Rodriguez Blanco Manuel, Molina Santos Victor, Gonzalo Prats Berta, Espinet Blasco Marina, Moral Duarte Antonio and Sánchez Cabús Santiago
World journal of Minimal Access Surgery 2021, 9:1

Abstract

Introduction

The incidence of biliary fistulas after laparoscopic exploration of the main bile duct (LCBDE) for the treatment of choledocholithiasisis is 5-% after closing the choledochotomy. We evaluate the usefulness of fibrin sealants in reducing the incidence of biliary fistulas.

Material and methods

We present a retrospective analysis of 110 patients diagnosed with choledocholithiasis who underwent LCBDE between September 2006 and April 2020. The study population was divided into two groups: patients with choledochorrhaphy covered with fibrin sealant adhesive (FS) and patients with uncovered choledochorrhaphy (NSF). We present the analysis of incidence of postoperative biliary fistulas.

Results

89 patients underwent the transcholedochal approach, 19.1% (17/89) choledochorraphy over a Kehr drain (CK) and 80.9% primary choledochorrhaphy (72/89). In the group undergoing closure with primary choledochorrhaphy (PC), 58% (42/72) received fibrin sealant (FS) and 42% (30/72) did not (NFS). In the group undergoing closure over a Kehr drain (CK), 41.2% (7/17) of patients received FS and 58.8% (10/17) NFS.

Analysis of the effect of the sealant in each subgroup found that applying fibrin sealant reduced the incidence of biliary fistulas in the PC group (5% in FS vs 40% in NFS, p 0.0005), but not in the CK group (14.3% in FS vs 10% in NFS, p=1).

Conclusion

Vaporized fibrin adhesive on choledochorrhaphy after primary bile duct closure may play an important role in significantly reducing the incidence of postoperative biliary fistulas.

Keywords

Laparoscopic common bile duct exploration, Choledocholithiasis, fibrin sealant, biliary fistulas, primary choledochorrhaphy.




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