Factors Influencing Bile Leakage and Incisional Infection Post-Choledocholithotomy: An Analysis Based on 621 Patients.

INTRODUCTION

Choledocholithiasis is a common biliary disorder, and laparoscopic choledochotomy remains an important treatment, particularly for large stones or complex anatomy. Bile leakage and incisional infection are frequent postoperative complications that can prolong recovery, yet their risk factors and interrelationship remain poorly defined. This study aimed to identify independent risk factors for these complications and explore the potential association between them to guide prevention strategies and improve patient outcomes.

METHODS

A retrospective study was conducted on 621 patients who underwent laparoscopic or open choledocholithotomy combined with cholecystectomy between January 2017 and October 2023. Clinical data were collected, and univariate analysis followed by binary logistic regression was used to identify independent risk factors for postoperative bile leakage and incisional infection.

RESULTS

Bile leakage occurred in 60 patients (9.7%). Multivariate analysis showed that open surgery (OR = 1.672), acute biliary inflammation (OR = 2.469), advanced age (OR = 1.061), continuous suturing (OR = 4.991), prolonged operative time (OR = 1.005), and bile pathogen infection (OR = 2.37) were independent risk factors (all p < 0.05). Among 181 patients who underwent open or converted surgery, 40 (22.1%) developed incisional infections. Independent risk factors for incisional infection included advanced age (OR = 1.055), prolonged operation time (OR = 1.006), elevated postoperative WBC count within 24 h (OR = 1.149), emergency surgery (OR = 3.745), longer incision length (OR = 1.141), and postoperative bile leakage (OR = 14.027) (all p < 0.05), indicating a strong association between bile leakage and subsequent wound infection.

CONCLUSION

Open surgery, acute inflammation, older age, continuous suturing, and biliary tract infection significantly increase the risk of postoperative bile leakage. Moreover, bile leakage was identified as a strong independent predictor of incisional infection. In addition, prolonged operative time, elevated early postoperative leukocyte count, emergency surgery, and longer incisions were also associated with increased incisional infection risk.