Appropriate Patient Selection Is Essential for the Success of Primary Closure After Laparoscopic Common Bile Duct Exploration

• Published in: Digestive diseases and sciences Vol. 62; no. 5; pp. 1321 - 1326
• Main Authors: Wen, Shun-Qian, Hu, Qiu-Hui, Wan, Ming, Tai, Sheng, Xie, Xue-Yi, Wu, Qing, Yang, Shang-lin, Liao, Guan-Qun
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.05.2017; Springer; Springer Nature B.V
• Subjects: Adult; Aged; Biochemistry; Common Bile Duct - surgery; Comparative analysis; Female; Gallstones - surgery; Gastroenterology; Hepatology; Humans; Laparoscopic surgery; Laparoscopy; Laparoscopy - methods; Male; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Middle Aged; Oncology; Original Article; Patient Selection; Retrospective Studies; Transplant Surgery; Wound Closure Techniques; T tube; Common bile duct; Laparoscopic surgery; Primary closure; Common bile duct stone; Common bile duct exploration
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-017-4507-0

Background Laparoscopic common bile duct exploration (LCBDE) is being increasingly used for management of common bile duct (CBD) stones. Primary CBD closure has been reported to have better short-term outcomes compared to T-tube placement. However, primary CBD closure cannot be performed in all patients. Aim This study aims to evaluate the short- and long-term outcomes of LCBDE with primary CBD closure in appropriately selected patients and compare them with T-tube drainage. Methods Retrospective analysis of patients undergoing LCBDE in our department from June 2011 to October 2014 was performed. Primary closure was performed in 52 patients (group A), and a T-tube was placed in 33 patients (group B). Patient demographics, intraoperative findings, postoperative stay, complications, and long-term follow-up data were recorded and compared. Results The mean operating time was much longer in group A compared to group B (113.92 vs. 95.92 min, p  = 0.032). The overall complication rate (9.6 vs. 6.3%, p  = 0.701) and hospital stay (4 vs. 5.11 days, p  = 0.088) were similar in both groups. No patient required conversion to the open procedure. Bile leakage was more frequent in group A (5.78 vs. 0%, p  = 0.279), but this was not statistically significant. All three patients with bile leakage were treated successfully by conservative measures and gradual drain withdrawal. On long-term follow-up, recurrent stones were detected in two patients in group A. No patient was found to develop CBD stricture. Conclusion LCBDE and primary CBD closure has excellent short- and long-term outcomes when performed in appropriately selected patients.