Feasibility and safety of choledochotomy primary closure in laparoscopic common bile duct exploration without biliary drainage: a retrospective study

Abstract

Common bile duct (CBD) exploration and T-tube drainage are the main surgical methods for the removal of bile duct stones (BDSs), which can now be completed by laparoscopy. However, the feasibility and safety of primary closure of the CBD (PCCBD) in laparoscopic CBD exploration (LCBDE) without biliary drainage are still uncertain. From January 1, 2021, to June 30, 2022, patients who were diagnosed with BDSs and underwent LCBDE and primary closure of the CBD without biliary drainage in our hospital were included. The clinical and prognostic data of the patients were retrospectively analyzed to determine the feasibility and safety of PCCBD in LCBDE without biliary drainage. Forty-nine patients successfully underwent PCCBD in LCBDE without biliary drainage. The operation time was 158.8 ± 50.3 (90–315,150) minutes, the bile duct suture time was 17.6 ± 4.46 (10–26, 18) minutes, the intraoperative blood loss volume was 70.4 ± 52.6 (5–200, 80) ml, the hospitalization cost was 28,141.2 ± 7011.3 (15,005.45–52,959.34, 26,815.14) CNY Yuan, the hospitalization time was 13.22 ± 5.16 (8–32, 12) days, and the postoperative hospitalization time was 7.31 ± 1.94 (3–15, 7) days. There were 3 cases of postoperative bile leakage (3/49, 6.12%), all of them healed by nonsurgical treatment. During the follow-up of 17.2 ± 11.01 (10–26, 17) months, no residual BDSs, biliary stricture or other complications classified as Clavien-Dindo grade I or higher occurred. For some selected patients who meet certain criteria, PCCBD in LCBDE without biliary drainage is feasible and safe and is more conducive to the rapid postoperative recovery of patients.

Comparison of the therapeutic effects of three minimally invasive approaches for laparoscopic cholecystectomy combined with common bile duct exploration—— a 5-year retrospective analysis

“…Furthermore, in some cases, long-term bile reflux caused by an incision in the sphincter of the ampulla of Vater may lead to the recurrence of bile duct stones and the development of biliary tract tumors [ 13 , 14 ]. Laparoscopic common bile duct exploration (LCBDE), which involves laparoscopic choledochotomy for stone removal combined with choledochoscopy, has emerged as an advantageous approach [ 15 ]. Studies have indicated that LCBDE is often a preferred option in many cases [ 14 ].…”

“…However, analysis of postoperative complications revealed that patients in the primary closure group had the highest incidence of bile leakage. Further investigation revealed that this occurrence was primarily due to an excessive number of stones within the bile duct [ 15 ]. The occurrence of such complications is attributed to repeated manipulation of the sphincter of the ampulla of Vater during stone extraction, resulting in spasms, edema, and even bleeding [ 22 ].…”

“…We believe that the larger diameter of the T-tube compared to the diameter of the double J-tube allows for better bile drainage and a reduction in intrabile duct pressure, thereby resulting in a lower incidence of postoperative bile leakage. This external drainage method is suitable for patients with a large number of intrabile duct stones who require multiple stone removal procedures, as well as those with severe symptoms of bile duct inflammation and significant bile duct wall edema [ 15 ]. Studies have indicated that T-tube drainage is particularly suitable for patients who have undergone secondary biliary tract surgery or who have a history of abdominal surgery [ 23 ].…”