Comparison Of Primary Suture And T Tube Drainage Of Common Bile Duct After Laparoscopic Common Bile Duct Exploration

Objective: To compare the clinical efficacy between primary suture and T tube drainage of common bile duct after laparoscopic common bile duct exploration,and to explore the feasibility,safety and application value of primary suture of common bile duct after laparoscopic cholecystectomy plus laparoscopic common bile duct exploration for the treatment of common bile duct stones and gallbladder stones.Methods: The clinical data of fifty-eight patients with common bile duct stones and gallbladder stones who underwent laparoscopic cholecystectomy plus laparoscopic common bile duct exploration from October 2014 to December 2016 in our hospital were retrospectively analyzed and enrolled according to the inclusion criteria.According to Primary suture or T tube drainage of common bile duct after the laparoscopic common bile duct exploration were divided into two groups:primary suture group(PS group)25 cases and T tube drainage group(TD group)33 cases.Duration of operation,intraoperative blood loss,postoperative intraperitoneal drainage,postoperative infusion volume,postoperative anal exhaust time,postoperative hospital stay,hospitalization cost and postoperative complications were compared between the two groups.Results: There was no death case in two groups.PS group vs TD group: intraoperative blood loss(ml)(41.00±17.80 vs 39.00±14.06 P=0.634),postoperative drainage volume(ml)and[34.00(14.00~41.50)vs 20.00(17.00~32.00)P=0.352],there was no significant difference between the two groups;however,the time of surgery(min)(130.44±12.07 vs 165.00±22.81 P=0.000),postoperative infusion volume(ml)(10771.60±1666.84 vs 12462.06±877.35 P=0.000),anal exhaust time(h)[42.00(38.00~45.50)vs 44.00(43.50~46.00)P=0.001],postoperative hospitalization time(d)[7.00(6.00~8.00)vs 8.00(7.00~8.50)P=0.010],hospitalization cost(yuan)(21374.12±1003.08 vs 22756.18±1327.83 P=0.000),PS group was significantly better than TD group,there were significant differences between the two groups;In the postoperative complications: PS group had 1 cases of mild bile leakage;TD group had 1 cases of mild bile leakage,1 cases of residual common bile duct stones,1 cases of bile peritonitis after removal of T tube,1 cases of hypokalemia,1 cases of metabolic acidosis syndrome,there was no significant difference in the incidence of postoperative complications between PS group and TD group(P>0.05);Two groups of patients were followed up for an average of 13 months(range 3 to 24 months)were not obvious biliary stricture.Conclusion: Primary suture of common bile duct after laparoscopic common bile duct exploration has obvious advantages compared with T tube drainage in the operation time,postoperative infusion volume,anal exhaust time,postoperative hospitalization time and hospitalization cost,Primary suture of common bile duct after laparoscopic common bile duct exploration does not increase the incidence of postoperative complications,and obtained satisfactory clinical outcome.So do the assessment in selected cases of preoperative,intraoperative skilled laparoscopic and choledochoscopic operation combined with endoscopic suturing and knotting technique good,master the indications of primary suture of common bile duct after laparoscopic common bile duct exploration,primary suture of common bile duct after laparoscopic cholecystectomy plus laparoscopic common bile duct exploration for the treatment of common bile duct stones and gallbladder stones is safe,effective and worthy of clinical application.