Evaiuation Of Result Of Primary Closure Of Bile Duct After Laparoscopic Common Bile Duct Exploration

Objective:To explore the feasibility and evaluate the result of primary closure of bile duct after laparoscopic common bile duct exploration.Method:Clinical data of138cases with choledocholithiasis and gallstone in our hospital from June2004to october2010were retrospectively analyzed. Cases were seperated to three teams (team1:primary closure of bile duct after laparoscopic cholecystectomy and common bile duct exploration; team2:laparoscopic cholecystectomy and common bile duct exploration with T tube drainage; team3: cholecystectomy and common bile duct exploration with T tube drainage.). The operation time, blood loss, anal exhaust time, postoperative hospital stay.and the incidence of bile leakage, residual stones, bile duct stricture in three teams were analyzed.Result:There were54cases in team1. In this team, the operation time was62-225min (mean122.37±20.12min). the blood loss was60-210ml (mean118.26=11.24ml), the anal exhaust time was14-63h (mean41.98±8.78h). the postoperative hospital stay was5-11d (mean7.09±1.12d). minor bile leakage happened in3cases (5.56%) and recovered after drainage. There were43cases in team2.In this team, the operation time was63-227min (mean123.47±20.31min), the blood loss was62-214ml (mean119.12±11.31ml), the anal exhaust time was15-62h (mean42.14±8.80h), the postoperative hospital stay was7-14d (mean10.12±1.88d), minor bile leakage happened in2cases (4.65%) and recovered after drainage. There were41cases in team3. In this team, the operative time was56-156min (mean89.61±9.12min), the blood loss was72-420ml (mean252.24±25.82ml), the anal exhaust time was28-98h (mean58.73±9.86h), the postoperative hospital stay was9-16d (mean12.02±2.13d), minor bile leakage happened in1case and recovered after drainage. All the patients were followed up for6months to2years and there were no residual stones and bile duct stricture. Comparing to team3, team1had longer operation time (q=13.70, P<0.05), but less blood loss (q=48.30, P<0.05), faster recovery of intestinal function after surgery (anal exhaust time was shorter)(q=12.35. P<0.05), and shorter postoperative hospital stay (q=20.62, P<0.05). Comparing to team3, also team2had longer operation time (q=13.82, P<0.05), but less blood loss (q=43.63, P<0.05), faster recovery of intestinal function after surgery (anal exhaust time was shorter)(q=11.51, P<0.05), and shorter postoperative hospital stay (q=6.14, P<0.05). Compraring to team2, team1had advantages of non-T tube, less trauma, and shorter postoperative hospital stay (q=13.94, P<0.05), but operative time. blood loss, anal exhaust time (q respectively=0.38,0.52.0.13, P all>0.05) were no significant difference.The incidence of bile leakage, residual stones, bile duct stricture (x2respectively=0.57,0,0, P all>0.05) were no significant difference in three teams.Conclusion:It is a safe,effective and worth promoting operation for primary closure of bile duct after laparoscopic common bile duct exploration with suitable indications and good operation techniques..