JIANG Kangyi , GAO Fengwei , LEI Zehua , XIE Qingyun , ZHAO Xin , WU Jianping , FU Jinqiang , DU Bo , WANG Zhixu , GONG Jie , XUE Qian
  • Department of Hepatobiliary and Pancreatic Surgery, People’s Hospital of Leshan/Diagnosis and Treatment Center of Hepatobiliary Pancreatic Splenic Systemic Disease in Leshan City, Leshan, Sichuan 614000, P. R. China;
GAO Fengwei, Email: 707850255@qq.com
laparoscopic cholecystectomy; “A-B-D” approach; bile duct injury; intraoperative bleeding
10.7507/1007-9424.202104050
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Objective To investigate the clinical value of laparoscopic cholecystectomy following “A-B-D” approach applied in the operation of acute suppurative or gangrenous cholecystitis.Methods We sought out 45 patients diagnosed as acute suppurative or gangrenous cholecystitis and treated by laparoscopic cholecystectomy following the “A-B-D” approach in People’s Hospital of Leshan from Sep. 2019 to Dec. 2020 as the observation group (ABD observation group), and sought out 50 patients with the same diseases but treated by conventional laparoscopic cholecystectomy from Jun. 2018 to Aug. 2019 as the matched group (conventional matched group). We analyzed and compared the parameters related to safety and efficacy of the two groups retrospectively.Results A total of 95 patients were included, including 45 patients in the ABD observation group (26 cases of acute suppurative cholecystitis, 19 cases of acute gangrenous cholecystitis) and 50 patients in the conventional matched group (24 cases of acute suppurative cholecystitis, 26 cases of acute gangrenous cholecystitis). There were no significant differences in age, gender, body mass index, disease composition, gallbladder condition, and preoperative complications between the two groups (P>0.05). There was no bile duct injury case in the ABD observation group (0), while there were 4 cases (8.0%) in the conventional matched group, but the statistical results showed no statistical significance between the two groups (P=0.054). One case (2.2%) in the ABD observation group converted to laparotomy, which was significantly lower than the 10 cases (20.0%) in the conventional matched group, and the difference was statistically significant (P=0.017). In addition, there were no significant differences for other parameters including operative time, postoperative hospital stay, incidences of intraoperative bleeding and postoperative bleeding between the two groups (P>0.05).Conclusions The laparoscopic cholecystectomy following the “A-B-D” approach can help distinguish the anatomical structure of cystic duct and extrahepatic bile duct clearly, and it can help prevent biliary tract injury effectively and reduce the probability of conversion to laparotomy. It is worthy of clinical application and promotion, especially in the majority of county hospitals.

Citation： JIANG Kangyi, GAO Fengwei, LEI Zehua, XIE Qingyun, ZHAO Xin, WU Jianping, FU Jinqiang, DU Bo, WANG Zhixu, GONG Jie, XUE Qian. Comparative study of laparoscopic cholecystectomy following the “A-B-D” approach andconventional laparoscopic cholecystectomy in the treatment of acute pyogenic and gangrenous cholecystitis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(1): 67-71. doi: 10.7507/1007-9424.202104050 Copy

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