Five Year Experience For Laparoscopic Common Bile Duct Exploration And Comparison Between T-Tube Drainage And Primary Duct Closure

Objective:This study aim to figure out better laparoscopic surgery option for common bile duct exploration through comparing two different kinds of surgeries that operated in our department in the past five years,and evaluate the feasibility and safety of the primary duct closure.Method:This study was a retrospective analysis of the 154 patients who underwent common bile duct exploration in our department(The Second Hepatobiliary Surgery Department,Zhujiang Hospital of Southern Medical University,Guangzhou,China)from August 2013 to August 2018.103 of them were used T-tube drainage and 51 of them were used primary duct closure.We collected all the data retrospectively from the patients’first and readmission charts.The missed or none written parts of the required data were left blank and did not participate in the statistics.All patients had at least 1 preoperative abdominal ultrasound,most of the patients at least had 1 preoperative Magnetic resonance cholangiopancreatography(MRCP).The study was approved by the Instistutional Review Board of Zhujiang Hopital of Southern Medical University.Informed consent was waived due to the retrospective nature of this study,and data were analyzed anonymously.Results:The overall complication rate was 22.7%(35/154),for T-tube drainage group was 26.2%(27/103),this was significantly higher than primary closure group which was 15.6%(8/51).Retained stone was number one complication,18 in T-tube drainage group(17 were cured with sinus tract choledochoscopy,1 was cured with second time laparoscopy)and 1 in primary closure group(cured with second time laparoscopy),accounts for 12.3%of all complications.3 bile leakages in T-tube drainage group 2.9%versus 5 bile leakages in primary closure group 9.8%,all cured with the elongation of the drainage time.2 common bile duct stricture in T-tube drainage group 1.9%(1 of them cured with ERCP stenting,the other cured with ERCP stenting and PTCD),1 common bile duct stricture in primary closure group 1.9%which was cured with ERCP stenting.1 reoccured stone in each group1.2%.The mortality rate was 0.Conclusion:Primary closure after laparoscopic common bile duct exploration is a more safe and economical surgical technique with low complication rates,less hospital stay,less bleeding,less operating time and less suffering for the patients than traditional T-tube drainage method.However,we have to choose wisely between two techniques when we treat patients with acute pancreatitis and the patients who are at a high risk for bile leakage.