ICG Fluorescence Cholangiography in Laparoscopic Transductal Common Bile Duct Exploration in Patients With Previous Upper Abdominal Surgery: A Propensity Score-matched Analysis

Abstract

Background. Previous upper abdominal surgeries (PUAS) hamper the identification and dissection of the common bile duct (CBD) during laparoscopic transductal common bile duct exploration (LCBDE). Indocyanine green (ICG) fluorescence cholangiography enables the real-time identification of extrahepatic bile ducts. However, the tissue penetration of ICG fluorescence is limited. The objective of the study was to evaluate the feasibility and effectiveness of ICG fluorescence-guided LCBDE in patients with PUAS. Methods. A total of 176 patients who underwent either conventional LCBDE (n = 99) or ICG-guided LCBDE (n = 77) were enrolled in the study. A 1:1 matched, propensity score-matched analysis was performed using the following factors: gender, age, BMI, ASA score, CBD diameter, number of CBD stones, and previous surgical approach. The surgical outcomes of the two groups were compared. Results. A well-balanced cohort of 122 patients was analyzed (n = 61 in the conventional group and n = 61 in the ICG group). The incidence of positive fluorescence in patients with PUAS was 88.5%. Time of CBD identification and total surgical duration were shorter in the ICG group with less intraoperative blood loss compared to the conventional group. There was no significant difference in the time of drainage tube extraction, conversion rate to open surgery, and intraoperative complication incidence between the two groups. Patients in the ICG group exhibited faster postoperative recovery, milder inflammatory responses, and reduced overall postoperative complication rate. Conclusions. ICG fluorescence cholangiography contributes to faster identification of CBD, improved postoperative recovery, and fewer postoperative complications in patients with PUAS.