Primary Closure versus T Tube Drainage in Laparoscopic Common Bile Duct Exploration: Has the Paradigm Already Changed?

Abstract

Purpose: The question of how to close de common bile duct (CBD) following of laparoscopic bile duct exploration (LCBDE) remains a topic of debate. Traditionally, the CBD is closed with T-tube drainage after choledochotomy and removal of CBD stones. With advances in laparoscopic instrumentation and acquisition of advanced laparoscopic skills primary duct closure without a T-tube has been proposed as an alternative. In recent studies primary closure has been showing less complications, shorter hospitalization stay and reduced operative times discouraging the routine use of T-tube after LCBDE. The aim of this study is to compare the safety and effectiveness of primary closure with T-tube drainage in laparoscopic common bile duct exploration (LCBDE) for choledocholithiasis. Method: Observational, retrospective study of patients undergoing LCBDE between January 2012 and May 2020. Descriptive and statistical analysis was performed with SPSS 25. Results: 71 patients underwent LCBDE with a transcholedochal approach (62% female, median age 67 years). Choledocoscopy was executed in 46.5% of the patients. Primary closure rate was 29.6%. The T-Tube group had a higher complications rate (24.5% vs 23.8%) and an inferior CBD stone clearance rate (87,8% vs 90.5%). The reintervention (7% vs 4.8%) and the hospital stay were superior in the T-tube group (7.6 vs 5.8 days). Conclusion: Primary closure was adopted as a preferred method in recent years in our hospital. Even with these previous results, we can assume that primary closure is feasible and associated with fewer complications, less need for reintervention and shorter hospital stay than T-tube drainage. Based on these results, primary duct closure may be considered as the optimal procedure for CBD closure after LCBDE.