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

Purpose: To identify independent risk factors for bile leakage and incisional infection after choledocholithotomy and to explore the potential association between bile leakage and incisional infection.

Methods: A retrospective study was conducted on 621 patients who underwent laparoscopic or open choledocholithotomy combined with cholecystectomy between January 2017 and October 2024. 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 hours (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 intra-biliary 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 infection risk.