Primary closure after laparoscopic common bile duct exploration is feasible for elderly patients: 5-Year experience at a single institution

Zhan, Zhi-Hui; Han, Hui; Zhao, Dongbo; Song, Guodong; Hua, Jie; Xu, Bin; Song, Zhijun

doi:10.1016/j.asjsur.2019.04.009

Cited by 19 publications

(16 citation statements)

References 33 publications

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“…Bile leakage following primary closure is a major criterion for assessing the safety of LCBDE with primary closure for the treatment of CBDS-related cholangitis. In our series, 5 patients (5/193, 2.59%) in the PC group and 3 patients (3/62, 4.84%) in the T-tube group experienced postoperative bile leakage, which is comparable with the bile leakage rates of 2.5–7% reported by other studies [ 12 , 15 , 39 , 40 ]. Previous studies have shown that T-tube do not prevent bile leakage [ 9 , 35 ].…”

Section: Discussionsupporting

confidence: 88%

Efficacy and safety of laparoscopic common bile duct exploration via choledochotomy with primary closure for the management of acute cholangitis caused by common bile duct stones

et al. 2021

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Background T-tube drainage after laparoscopic common bile duct exploration (LCBDE) has been demonstrated to be safe and effective for patients with acute cholangitis caused by common bile duct stones (CBDSs). The outcomes after LCBDE with primary closure in patients with CBDS-related acute cholangitis are unknown. The present study aimed to evaluate the efficacy and safety of LCBDE with primary closure for the management of acute cholangitis caused by CBDSs. Methods Between June 2015 and June 2020, 368 consecutive patients with choledocholithiasis combined with cholecystolithiasis, who underwent laparoscopic cholecystectomy (LC) + LCBDE in our department, were retrospectively reviewed. A total of 193 patients with CBDS-related acute cholangitis underwent LC + LCBDE with primary closure of the CBD (PC group) and 62 patients underwent LC + LCBDE followed by T-tube placement (T-tube group). A total of 113 patients who did not have cholangitis were excluded. The clinical data were compared and analyzed. Results There was no mortality in either group. No significant differences were noted in morbidity, bile leakage rate, retained CBD stones, or readmission rate within 30 days between the two groups. Compared with the T-tube group, the PC group avoided T-tube-related complications and had a shorter operative time (121.12 min vs. 143.37 min) and length of postoperative hospital stay (6.59 days vs. 8.81 days). Moreover, the hospital expenses in the PC group were significantly lower than those in the T-tube group ($4844.47 vs. $5717.22). No biliary stricture occurred during a median follow-up of 18 months in any patient. No significant difference between the two groups was observed in the rate of stone recurrence. Conclusions LCBDE with primary closure is a safe and effective treatment for cholangitis caused by CBDSs. LCBDE with primary closure is not inferior to T-tube drainage for the management of CBDS-related acute cholangitis in suitable patients.

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Section: Discussionsupporting

confidence: 88%

Efficacy and safety of laparoscopic common bile duct exploration via choledochotomy with primary closure for the management of acute cholangitis caused by common bile duct stones

et al. 2021

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“…and all drainage tube indwelling time 6(5,7) vs 84(82,86.5) was shorter in the primary suture group(P 0.05). And there were statistically significant differences in postoperative total drainage volume on the first day 15 (15,58.75) vs 292(185, 360), all drainage tube indwelling time 6(5, 7) vs 84(82, 86.5), postoperative total bilirubin 22.15 (13.475, 33) vs 31.3 (20.6,57.3) and residual stones (0/56 vs 5/29) between the two groups (P<0.05). There were no statistically significant differences in the other intraoperative and postoperative characteristics(P 0.05).…”

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confidence: 89%

“…After clearing the stones, primary suture of the common bile duct could protect the patients from long-term T-tube drainage 12 . The primary suture of the common bile duct had been reported in previous studies, which showed that it was feasible [13][14][15] .…”

Section: Introductionmentioning

confidence: 99%

The effect of the laparoscopic primary suture of the common bile duct in elderly patients: a retrospective study

Liu

Wang

Liu

et al. 2019

Preprint

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Background The surgery treatment strategies for elderly patients who were diagnosed as choledocholithiasis combined with cholecystolithiasis include laparoscopic choledocholithotomy with cholecystectomy and T-tube drainage or endoscopic sphincterotomy with nasobiliary drainage alone for those selected elderly patients without symptoms related to the gallbladder. However, long-term T-tube drainage will cause pain and life inconvenient. This study was designed to retrospective analysis the primary suture of the common bile duct and the T-tube drainage after laparoscopic choledochotomy to study the merits and demerits between primary suture and T-tube drainage in elderly patients. Methods Eighty-five patients were screened from January 2017 to January 2018. All patients were performed laparoscopic surgery, and an intraperitoneal drainage tube was left in all patients. Fifty-six cases were the primary suture group (n=56). Twenty-nine cases were the T-tube group (n=29). Preoperative baseline characteristics, intraoperative and postoperative characteristics of the two groups were compared. Results There were no differences in baseline characteristics in both groups (P＞0.05). Compared with the T-tube group, the postoperative total drainage volume on the first day [15(15, 58.75) vs 292(185, 360)] and patients of residual stones (0/56 vs 5/29) were fewer, and all drainage tube indwelling time [6(5,7) vs 84(82,86.5)] was shorter in the primary suture group(P﹤0.05). And there were statistically significant differences in postoperative total drainage volume on the first day [15(15, 58.75) vs 292(185, 360)], all drainage tube indwelling time [6(5, 7) vs 84(82, 86.5)], postoperative total bilirubin [22.15(13.475, 33) vs 31.3(20.6,57.3)] and residual stones (0/56 vs 5/29) between the two groups (P<0.05). There were no statistically significant differences in the other intraoperative and postoperative characteristics(P＞0.05). There were no pressure sores, postoperative pneumonia, deep vein thrombosis, serious complications of heart, lung and brain and even death in both groups. Conclusions With accurate preoperative risk assessment and strict treatment of basic diseases for elderly patients, if the stones in the common bile duct were cleared in laparoscopic surgery, the primary suture in elderly patients is feasible, safe, and valid.

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“…Finally, a silicon drainage tube was inserted through the lateral trocar and fixed on the port of right anterior axillary line (9,11).…”

Section: Operative Techniquesmentioning

confidence: 99%

Primary closure combined with C-tube drainage through cystic duct after laparoscopic common bile duct exploration is safe and feasible for patients

Sui

et al. 2022

Front. Surg.

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ObjectiveBiliary duct management is of great significance after laparoscopic cholecystectomy (LC) combined with laparoscopic common bile duct exploration (LCBDE) in the treatment of cholecystolithiasis accompanied with common bile duct (CBD) stones. This study is to evaluate the safety and effectiveness of primary closure with C-tube drainage through cystic duct after LC + LCBDE.MethodsThrough a retrospective study, 290 patients who underwent LC + LCBDE in our hospital from January 2019 to April 2022 were enrolled and divided into 2 groups. 143 patients underwent primary closure with C-tube drainage through cystic duct (C-tube group) and the other 147 patients underwent traditional T-tube drainage (T-tube group). Personal information, perioperative examinations, surgical results, and follow-up results were collected and analyzed.ResultsThere were no significant differences in the average age, gender, the mean of CBD diameters and the rate of comorbidities (acute cholecystitis, obstructive jaundice, acute pancreatitis and acute cholangitis) between the two groups (P > 0.05). Hospital stay, postoperative hospital stay were significantly shorter in the C-tube group than T-tube group (P < 0.05). In addition, the average time of placing and removal the drainage tubes was significantly less than those of the T-tube group (P < 0.05). This study also showed significant differences in the incidence of postoperative abdominal infection and soft tissue infection in the two groups (P < 0.05). There were no significant differences in the incidence of postoperative complications including cholangitis, bile duct stenosis, mortality in two groups. There were also no significant differences between the two groups of the recurrence of CBD stones, reoperation and readmition in 30 days during the median follow-up of 6 months.ConclusionsCompared with T tube drainage, patients with C-tube drainage after LC + LCBDE with primary closure of cystic duct recovered faster and had fewer complications. C-tube drainage is a safe and feasible treatment option for patients with cholecystolithiasis and choledocholithiasis.

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Primary closure after laparoscopic common bile duct exploration is feasible for elderly patients: 5-Year experience at a single institution

Cited by 19 publications

References 33 publications

Efficacy and safety of laparoscopic common bile duct exploration via choledochotomy with primary closure for the management of acute cholangitis caused by common bile duct stones

Efficacy and safety of laparoscopic common bile duct exploration via choledochotomy with primary closure for the management of acute cholangitis caused by common bile duct stones

The effect of the laparoscopic primary suture of the common bile duct in elderly patients: a retrospective study

Primary closure combined with C-tube drainage through cystic duct after laparoscopic common bile duct exploration is safe and feasible for patients

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