Comparative study of different bile duct closure methods for laparoscopic common bile duct discovery for choledocholithiasis

Abstract

Objective To analyze the therapeutic effect of different bile duct closure methods for laparoscopic common bile duct exploration for choledocholithiasis. Methods The clinical data of two hundred and ninety-eight patients who underwent laparoscopic cholecystectomy and choledocholithotomy from June 2012 to May 2017 in Chancheng Central Hospital of Foshan and the First People’s Hospital of Foshan were retrospectively analyzed. The incidence of severe complications (Clavien-Dindo> III), the incidence of bile leakage (Grade A/B/C), hospitalization time, re-admission rate, recurrence of common bile duct stones and other related complications were compared among patients with different closure modes of common bile duct. Results There were 74 cases (24.8%) undergoing primary suture of common bile duct, 118 cases (39.6%) undergoing T-tube drainage and 106 cases (35.6%) undergoing stent drainage. The hospitalization time of patients with primary suture, T-tube drainage and stent drainage was 2-30 (5.8±3.7) days, 7-75 (11.6±8.9) days and 7-56 (9.8±5.1) days, respectively, the difference was statistically significant (F=5.96, P=0.04); the re-admission rates were 0 (0/74), 10.2% (12/118) and 5.7% (6/106), respectively (χ2=8.25, P=0.02); the total incidence of postoperative complications was 28.4% (21/74), 31.4% (37/118) and 27.4% (29/106) and the incidence of severe complications was 0 (0/74), 7.6% (9/118) and 4.7% (5/106), respectively, the difference was statistically significant (χ2=6.52, P=0.04); postoperative complications of biliary leakage was 23.0% (17/74), 16.9% (20/118) and 8.5% (9/106), respectively (χ2=7.34, P=0.02). However, Grade C bile leakage did not occur in primary suture of common bile duct and Grade B bile leakage was cured by prolonging drainage. Postoperative stone recurrence rates of patients with primary suture, T-tube drainage and stent drainage were 2.7% (2/74), 4.2% (5/118) and 11.3% (12/106), with statistically significant difference (χ2=6.91, P=0.03). Conclusions T-tube drainage and stent implantation after laparoscopic choledocholithotomy do not bring more benefits, on the contrary, there are many related complications. Although primary suture of common bile duct is prone to bile leakage after operation, there are few serious complications. Key words: Choledocholithiasis; Laparoscopy; Wound closure techniques; Drainage; Stents; Primary suture