Clinical application of common bile duct primary closure in laparoscopic and choledochoscopic choledocholithotomy

Abstract

Objective To investigate the safety and curative effect of common bile duct primary closure in laparoscopic and choledochoscopic choledocholithotomy. Methods Clinical data of 178 patients with choledocholithiasis diagnosed and treated in Chaozhou Central Hospital between January 2011 and December 2014 were retrospectively studied. Among the 178 patients, 83 were males and 95 were females with the average age of (46±3) years old. The informed consents of all patients were obtained and the local ethical committee approval had been received. All patients underwent laparoscopic and choledochoscopic choledocholithotomy and were divided into the primary closure group and the T-tube drainage group according to the different treatment for the incision of choledocholithotomy. The patients in the primary closure group underwent primary closure of common bile duct and the patients in the T-tube drainage group received T-tube drainage following choledocholithotomy. The operation duration, exhaust time, length of stay, hospitalization expenses and postoperative complication of two groups were observed. The observation indexes of two groups were compared using t test or Chi-square test. Results The patients in two groups completed choledocholithotomy successfully. The operation duration, exhaust time, length of stay, hospitalization expenses were respectively (119±18) min, (25±7) h, (6±1) d, (12 000±2 000) yuan in the primary closure group, and were respectively (136±20) min, (38±8) h, (10±1) d, (15 000±2 000) yuan in the T-tube drainage group. And significant difference was observed (t=2.38, 5.00, 7.21, 3.87; P<0.05). The incidence of postoprative complication in the primary closure group was 8%(3/37), which was significantly lower than 12%(17/141) in the T-tube drainage geoup (χ2=3.28, P<0.05). In the primary closure group, 3 patients developed bile leakage and 1 developed incision infection. In the T-tube drainage group, 1 patient developed bile leakage, 5 gallbladder fossa hydrops, 11 incision infection and 10 adhesive intestinal obstruction. All patients recovered after symptomatic treatments. Conclusion Common bile duct primary closure in laparoscopic and choledochoscopic choledocholithotomy is safe, effective and has the advantages of quick recovery, low costs and low complication incidence. Key words: Laparoscopes; Biliary tract; Choledocholithiasis; Suture techniques