Comparative study of three methods of bile duct colsure after laparoscopic common bile duct exploration for choledocholithiasis

Abstract

Objective To investigate the clinical value of three methods of bile duct closure after laparoscopic common bile duct exploration for choledocholithiasis. Methods A retrospective study was performed on 183 cases of patients with choledocholithiasis who were admitted from January 2011 to January 2018.There were 113 male and 70 female, aged(51.20±6.79)years old, the age range was 43 to 65 years old.According to the postoperative close method, patients were divided into three groups, respectively, T tube drainage, J tube drainage and issue of stitching.The three groups of patients with preoperative baseline data, operation time, intraoperative blood loss, postoperative rehydration capacity, drainage tube removal time, gastrointestinal ventilation time, postoperative hospital stay and postoperative biliary complications were observed. Results There were no statistically significant differences in the preoperative baseline data of gender, age, diameter of common bile duct, number of common bile duct stones, total bilirubin and direct bilirubin in the three groups(P>0.05). There were no statistically significant differences in intraoperative blood loss, drainage tube removal time and gastrointestinal ventilation time between the three groups(P>0.05). The operation time [(93.65±12.83)minutes], postoperative fluid supplementation [(5.38±0.93)L], postoperative hospital stay [(5.85±1.74)days] in the primary suture group were all lower than that in the T-tube drainage group [(115.34±13.85)minutes, (10.85±1.25)L, (10.83±3.47)days] and the J tube drainage group [(119.32±15.42)minutes, (10.63±1.48)L, (10.25±3.69)days], the differences were statistically significant(P 0.05). The incidence of residual stones, biliary stricture, postoperative bleeding and other complications in the three groups was not significantly different(P>0.05). The incidence of bile leakage in the J-tube drainage group was lower than that in the T-tube drainage group and the first-stage suture group, but the difference was not statistically significant(P>0.05). Conclusion Compared with T-tube drainage after laparoscopic choledocholithiasis laparoscopic choledocholithiasis, one-stage suture is beneficial to reduce surgical trauma and shorten hospitalization time, while regular self-removal of single J-tube drainage tends to reduce bile leakage, which is worthy of further discussion. Key words: Choledocholithiasis; Laparoscopic common bile duct exploration; T tube; J tube; Primary suture