Abstract
There are still many physicians who are reluctant to use primary biliary suture in Laparoscopic common bile duct exploration (LCBDE) for fear of more complications. We compare and analyze the clinical effectiveness of bile duct primary suture with three laparoscopic ports and indwelling T-tube drainage (with four laparoscopic ports) in patients with choledocholithiasis after LCBDE. Clinical data of 135 patients with common bile duct (CBD) stone were compared, including general conditions, postoperative hospital stay, postoperative complications, hospitalization costs, postoperative follow-up and other indicators. Forty-eight patients underwent primary suture of bile duct (group A) and 87 were treated with external T-tube drainage (group B). There were no significant differences between the two groups neither relating to the age, gender, BMI, diameter of CBD, number of stones, preoperative bilirubin value, number of previous surgeries in preoperative, nor the operation time, residual stones, the number of cases converted from laparoscopic conversion to laparotomy. The postoperative complications like fever, bleeding, incision infection, bile duct stricture has no differences between two group. The incidence of bile leakage (p = 0.008) and postoperative electrolyte disturbance (p = 0.001) were slightly lower in group A. There were fewer postoperative complications in group A vs group B (p = 0.04). Patients in group A experienced shorter postoperative hospital stay (p < 0.001), earlier postoperative extubation (p < 0.001), lower total hospitalization costs (p = 0.03), and earlier postoperative recovery (p = 0.000). Primary suture of CBD is a safe and effective method for some patients after LCBDE.
Similar content being viewed by others
Data availability
The data generated and/or analyzed during this study are available from the corresponding author on reasonable request.
References
Lee HM, Min SK, Lee HK (2014) Long-term results of laparoscopic common bile duct exploration by choledochotomy for choledocholithiasis: 15-year experience from a single center. Ann Surg Treat Res 86(1):1–6. https://doi.org/10.4174/astr.2014.86.1.1
European Association for the Study of the Liver (EASL). Electronic address: easloffice@easloffice.eu (2016) EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones. J hepatol 65(1): 146–181. doi: https://doi.org/10.1016/j.jhep.2016.03.005
Buxbaum J (2013) Modern management of common bile duct stones. Gastrointest Endosc Clin N Am 23(2):251–275. https://doi.org/10.1016/j.giec.2012.12.003
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae
Harris HW, Davis BR, Vitale GC (2005) Cholecystectomy after endoscopic sphincterotomy for common bile duct stones: is surgery necessary? Surg Innov 12(3):187–194. https://doi.org/10.1177/155335060501200302
Wang H, Zhang J, Lin X, Ou Y (2022) Laparoscopic common bile duct exploration with gallbladder preservation: an innovative technique for primary common bile duct stones. J Laparoendosc Adv Surg Tech A. https://doi.org/10.1089/lap.2021.0825
Ma Z, Zhou J, Yao L, Dai Y, Xie W, Song G, Meng H, Xu B, Zhang T, Zhou B, Yang T, Song Z (2022) Safety and efficacy of laparoscopic common bile duct exploration for the patients with difficult biliary stones: 8 years of experiences at a single institution and literature review. Surg Endosc 36(1):718–727. https://doi.org/10.1007/s00464-021-08340-1
Freitas ML, Bell RL, Duffy AJ (2006) Choledocholithiasis: evolving standards for diagnosis and management. World J Gastroenterol 12(20):3162–3167. https://doi.org/10.3748/wjg.v12.i20.3162
Iodice G, Giardiello C, Francica G, Sarrantonio G, Angelone G, Cristiano S, Finelli R, Tramontano G (2001) Single-step treatment of gallbladder and bile duct stones: a combined endoscopic-laparoscopic technique. Gastrointest Endosc 53(3):336–338. https://doi.org/10.1016/s0016-5107(01)70409-9
Ozcan N, Riaz A, Kahriman G (2021) Percutaneous management of biliary stones. Semin Interv Radiol 38(3):348–355. https://doi.org/10.1055/s-0041-1731373
Ogura T, Kawai J, Nishiguchi K, Yamamoto Y, Higuchi K (2022) Transluminal intrahepatic bile duct stone removal using a novel spiral basket catheter via the endoscopic ultrasound-guided hepaticogastrostomy route (with video). Dig Endosc 34(1):234–237. https://doi.org/10.1111/den.14121
He MY, Zhou XD, Chen H, Zheng P, Zhang FZ, Ren WW (2018) Various approaches of laparoscopic common bile duct exploration plus primary duct closure for choledocholithiasis: a systematic review and meta-analysis. Hepatobiliary Pancreat Dis Int 17(3):183–191. https://doi.org/10.1016/j.hbpd.2018.03.009
Yu Y, Cheng Y, Li T, Cheng B, Jin X (2019) Laparoscopic common bile duct exploration plus cholecystectomy versus endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy for cholecystocholedocholithiasis: a meta-analysis. Surg Endosc 33(10):3275–3286. https://doi.org/10.1007/s00464-018-06613-w
Nzenza TC, Al-Habbal Y, Guerra GR, Manolas S, Yong T, McQuillan T (2018) Recurrent common bile duct stones as a late complication of endoscopic sphincterotomy. BMC Gastroenterol 18(1):39. https://doi.org/10.1186/s12876-018-0765-3
Oliveira-Cunha M, Dennison AR, Garcea G (2016) Late complications after endoscopic sphincterotomy. Surg Laparosc Endosc Percutan Techn 26(1):1–5. https://doi.org/10.1097/SLE.0000000000000226
Tanaka M, Takahata S, Konomi H, Matsunaga H, Yokohata K, Takeda T, Utsunomiya N, Ikeda S (1998) Long-term consequence of endoscopic sphincterotomy for bile duct stones. Gastrointest Endosc 48(5):465–469. https://doi.org/10.1016/s0016-5107(98)70086-0
Monino L, Deprez PH, Moreels TG (2021) Percutaneous cholangioscopy with short Spyscope combined with endoscopic retrograde cholangiography in case of difficult intrahepatic bile duct stone. Dig Endosc 33(4):e65–e66. https://doi.org/10.1111/den.13935
Liu B, Ma J, Li S, Li C, Qi H, Nian D, Yin C, Zhu J, Wang C, Jia Y, Jiang T, Lu J, Wang L, Shen D, Hou X, Li D, Zhang Z, Du F, Wu H, Yu T, Li Y (2021) Percutaneous transhepatic papillary balloon dilation versus endoscopic retrograde cholangiopancreatography for common bile duct stones: a multicenter prospective study. Radiology 300(2):470–478. https://doi.org/10.1148/radiol.2021201115
Anjum MR, Dyer J, Curran F, Menon S (2018) Cholangioscopy-guided electrohydraulic lithotripsy of a large bile duct stone through a percutaneous T-tube tract. VideoGIE 3(12):390–391. https://doi.org/10.1016/j.vgie.2018.09.001
Deng M, Yan J, Zhang Z, Wang Z, Zhang L, Ren L, Fan H (2022) Greater than or equal to 8 mm is a safe diameter of common bile duct for primary duct closure: single-arm meta-analysis and systematic review. Clin J Gastroenterol. https://doi.org/10.1007/s12328-022-01615-7
Paganini AM, Guerrieri M, Sarnari J, De Sanctis A, D’Ambrosio G, Lezoche G, Lezoche E (2005) Long-term results after laparoscopic transverse choledochotomy for common bile duct stones. Surg Endosc 19(5):705–709. https://doi.org/10.1007/s00464-004-8944-4
Wang Q, Zhang X, Sun L, Yang N (2021) Primary two-layered closure of the common bile duct reduces postoperative bile leakage after laparoscopic common bile duct exploration. J Laparoendosc Adv Surg Tech A 31(11):1274–1278. https://doi.org/10.1089/lap.2020.0768
Xu B, Luo T, Yang T, Wang S, Meng H, Gong J, Zhou B, Zheng W, Song Z (2022) Laparoscopic common bile duct exploration with primary closure is beneficial for patients with previous upper abdominal surgery. Surg Endosc 36(2):1053–1063. https://doi.org/10.1007/s00464-021-08371-8
Acknowledgements
None.
Funding
None.
Author information
Authors and Affiliations
Contributions
Study concept: ZDY and LZ. Data collection: SWL, WN and LZ. First draft and Data analysis: ZDY and MY. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no competing interests.
Consent to participate
The patients’ written informed consent for publication were obtained.
Research involving human participants and/or animals and informed consent
This study was conducted in accordance with the principles of the Helsinki Declaration. The study was approved by the Ethics Committee of Bengbu Medical College.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Zhang, D., Ma, Y., Sun, W. et al. Primary suture for patients of bile duct stones after laparoscopic biliary tract exploration: a retrospective cohort study. Updates Surg 75, 897–903 (2023). https://doi.org/10.1007/s13304-023-01451-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13304-023-01451-5