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

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Abstract

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.

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References

  1. Lee HM, Min SK, Lee HK. Long-term results of laparoscopic common bile duct exploration by choledochotomy for choledocholithiasis: 15-year experience from a single center. Ann Surg Treat Res. 2014;86:1–6.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Yi HJ, Hong G, Min SK, Lee HK. Long-term outcome of primary closure after laparoscopic common bile duct exploration combined with choledochoscopy. Surg Laparosc Endosc Percutan Technol. 2015;25:250–253.

    Article  Google Scholar 

  3. Rhodes M, Sussman L, Cohen L, Lewis MP. Randomised trial of laparoscopic exploration of common bile duct versus postoperative endoscopic retrograde cholangiography for common bile duct stones. The Lancet. 1998;351:159–161.

    Article  CAS  Google Scholar 

  4. Tranter SE, Thompson MH. Comparison of endoscopic sphincterotomy and laparoscopic exploration of the common bile duct. Br J Surg. 2002;89:1495–1504.

    Article  CAS  PubMed  Google Scholar 

  5. Cuschieri A, Lezoche E, Morino M, et al. EAES multicenter prospective randomized trial comparing two-stage vs single-stage management of patients with gallstone disease and ductal calculi. Surg Endosc. 1999;13:952–957.

    Article  CAS  PubMed  Google Scholar 

  6. Abboud PA, Malet PF, Berlin JA, et al. Predictors of common bile duct stones prior to cholecystectomy: a meta analysis. Gastrointest Endosc. 1996;44:450–455.

    Article  CAS  PubMed  Google Scholar 

  7. Wu X, Yang Y, Dong P, et al. Primary closure versus T-tube drainage in laparoscopic common bile duct exploration: a meta-analysis of randomized clinical trials. Langenbecks Arch Surg. 2012;397:909–916.

    Article  PubMed  Google Scholar 

  8. Leida Z, Ping B, Shuguang W, Yu H. A randomized comparison of primary closure and T-tube drainage of the common bile duct after laparoscopic choledochotomy. Surg Endosc. 2008;22:1595–1600.

    Article  PubMed  Google Scholar 

  9. Cai H, Sun D, Sun Y, Bai J, Zhao H, Miao Y. Primary closure following laparoscopic common bile duct exploration combined with intraoperative cholangiography and choledochoscopy. World J Surg. 2012;36:164–170.

    Article  PubMed  Google Scholar 

  10. Audouy C, Thereaux J, Kansou G, Leroux G, Badic B, Bail JP. Primary closure versus biliary drainage after laparoscopic choledocotomy: Results of a comparative study. Surg Laparosc Endosc Percutan Tech. 2016;26:e32–e36. doi:10.1097/SLE.0000000000000242.

    Article  PubMed  Google Scholar 

  11. Estellés Vidagany N, Domingo Del Pozo C, Peris Tomás N, Díez Ares JÁ, Vázquez Tarragón A, Blanes MassonF. Eleven years of primary closure of common bile duct after choledochotomy for choledocholithiasis. Surg Endosc. 2016;30:1975–1982.

    Article  PubMed  Google Scholar 

  12. Muzaffar I, Zula P, Yimit Y, Jaan AT, Wen H. Randomized comparison of postoperative short-term and mid-term complications between T-tube and primary closure after CBD exploration. J Coll Physicians Surg Pak. 2014;24:810–814.

    PubMed  Google Scholar 

  13. Dong ZT, Wu GZ, Luo KL, Li JM. Primary closure after laparoscopic common bile duct exploration versus T-tube. J Surg Res. 2014;189:249–254.

    Article  PubMed  Google Scholar 

  14. Zhang WJ, Xu GF, Wu GZ, Li JM, Dong ZT, Mo XD. Laparoscopic exploration of common bile duct with primary closure versus T-tube drainage: a randomized clinical trial. J Surg Res. 2009;157:e1–e5.

    Article  PubMed  Google Scholar 

  15. Zhu QD, Tao CL, Zhou MT, Yu ZP, Shi HQ, Zhang QY. Primary closure versus T-tube drainage after common bile duct exploration for choledocholithiasis. Langenbecks Arch Surg. 2011;396:53–62.

    Article  PubMed  Google Scholar 

  16. Zhang LD, Bie P, Chen P, Wang SG, Ma KS, Dong JH. Primary duct closure versus T-tube drainage following laparoscopic choledochotomy. Zhonghua Wai Ke Za Zhi. 2004;42:520–523.

    PubMed  Google Scholar 

  17. Koch M, Garden OJ, Padbury R, et al. Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery. 2011;149:680–688.

    Article  PubMed  Google Scholar 

  18. Kehlet H, Wilmore DW. Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg. 2008;248:189–198.

    Article  PubMed  Google Scholar 

  19. Petelin JB. Laparoscopic common bile duct exploration. J Laparoendosc Surg. 2005;7:23–38.

    Google Scholar 

  20. Jameel M, Darmas B, Baker AL. Trend towards primary closure following laparoscopic exploration of the common bile duct. Ann R Coll Surg Engl. 2008;90:29–35.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Yang X, Ihim I, Kowdley GC, Cunningham SC. Letter to the editor regarding primary closure after laparoscopic common bile duct exploration versus T-tube. J Surg Res. 2015;194:341–342.

    Article  PubMed  Google Scholar 

  22. Gurusamy KS, Samraj K. Primary closure versus T-tube drainage after laparoscopic common bile duct stone exploration. Cochrane Database Syst Rev. 2007;1:CD005641.

    Google Scholar 

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Funding

This study was funded by a grant from Foshan Hospital affiliated to Southern Medical University.

Author’s Contribution

G-QL and TS conceived and designed the study; S-QW, SY, G-QL, and Q-HH retrieved and analyzed the data; X-YX and QW drafted the manuscript; GQ-L and MW assisted in the data analysis and reviewed the manuscript.

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Authors and Affiliations

  1. Department of Hepatobiliary Surgery, Affiliated Foshan Hospital of Southern Medical University, Wei Guo Road North, Foshan, 528000, China

    Shun-Qian Wen, Xue-Yi Xie, Qing Wu, Shang-lin Yang & Guan-Qun Liao

  2. Department of Hepatobiliary Surgery, Heilongjiang Province Second Cancer Hospital, Harbin, China

    Qiu-Hui Hu

  3. Department of General Surgery, The Second Hospital Affiliated to Harbin Medical University, Harbin, China

    Ming Wan & Sheng Tai

Authors
  1. Shun-Qian Wen
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  2. Qiu-Hui Hu
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  3. Ming Wan
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  4. Sheng Tai
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  5. Xue-Yi Xie
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  6. Qing Wu
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  7. Shang-lin Yang
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  8. Guan-Qun Liao
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Corresponding author

Correspondence to Guan-Qun Liao.

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The authors declare that they have no conflict of interest.

Ethical standard

For this type of study formal consent is not required.

Animal rights

This article does not involve any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Cite this article

Wen, SQ., Hu, QH., Wan, M. et al. Appropriate Patient Selection Is Essential for the Success of Primary Closure After Laparoscopic Common Bile Duct Exploration. Dig Dis Sci 62, 1321–1326 (2017). https://doi.org/10.1007/s10620-017-4507-0

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  • DOI: https://doi.org/10.1007/s10620-017-4507-0

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