Primary Closure after Laparoscopic CBD Exploration- Experience of More than 400 Cases over 12 Years at a Tertiary Care Center

Abstract

Introduction: T tube placement after common bile duct (CBD) exploration has been the standard since the era of open CBD exploration. We hereby report our experience and long term outcomes of over 400 cases of laparoscopic CBD exploration where in primary closure of CBD was done without T -Tube placement. Methods: All patients with CBD stones undergoing laparoscopic common bile duct exploration (LCBDE) in a single surgical unit at a tertiary care center were studied from April 2007 to October 2019. MRCP served as a road map and patients were taken up for LCBDE if the CBD diameter was more than 10 mm. Intraoperative details including the mode of closure of bile duct (primary, T Tube or endobilliary stent) were noted. The post-operative recovery, complications, hospital stay, antibiotic usage and post-operative intervention if any were also recorded. Results: 414 patients underwent LCBDE during this period. The mean age was 50 ± 15.2 years and majority were females (68.8%). 180 (43.47%) patients had failed ERCP. CBD was closed primarily in 97.58% (n=404) cases. Endobiliary stent was placed in 90 (21.73%) patients and only primary closure in 314 cases. T tube was used in 5 cases with a total of 34 conversion to open CBD exploration. Successful laparoscopic CBD clearance was achieved in 380 patients (success rate 91.80%). Conclusion: Primary closure of CBD following laparoscopic CBD exploration is safe and associated with minimal complications. The routine use of primary CBD closure after laparoscopic CBD exploration is recommended based on our experience.