Primary Closure Of Common Bile Duct Research Articles

Laparoscopic common bile duct exploration with primary closure could be safely performed among elderly patients with choledocholithiasis

BackgroundFor patients with choledocholithiasis, laparoscopic common bile duct exploration (LCBDE) is preferred over open surgery. Whether primary closure of the common bile duct (CBD) should be performed upon completion of choledochotomy remains unclear, and the corresponding indications for primary closure of the common bile duct have yet to be fully identified. This study was performed to evaluate the safety and feasibility of primary closure of CBD among elderly patients (≥ 70 years) after LCBDE.MethodsPatients with choledocholithiasis who had undergone LCBDE with primary closure of the CBD between July 2014 and December 2020 were retrospectively reviewed. Included patients were assigned into two groups (Group A: ≥70 years and Group B: <70 years) according to age. Group A was compared with Group B in terms of preoperative characteristics, intraoperative results and postoperative outcomes.ResultsThe mean operative time for Group A was 176.59 min (± 68.950), while the mean operative time for Group B was 167.64 min (± 69.635) (P = 0.324). The mean hospital stay after surgery for Group A was 8.43 days (± 4.440), while that for Group B was 8.30 days (± 5.203) (P = 0.849). Three patients in Group A experienced bile leakage, while bile leakage occurred in 10 patients in Group B (3.8% vs. 4.5%, P = 0.781). Group A was not significantly different from Group B in terms of postoperative complications and 30-day mortality except pneumonia (P = 0.016), acute cardiovascular event (P = 0.005) and ICU observation (P = 0.037). After a median follow-up time of 60 months, 2 patients in Group A and 2 patients in Group B experienced stone recurrence (2.5% vs. 0.9%, P = 0.612). One patient in Group A experienced stenosis of the CBD, while stenosis of the CBD occurred in 5 patients in Group B (1.3% vs. 2.2%, P = 0.937).ConclusionsPrimary closure of CBD upon completion of LCBDE could be safely performed among patients ≥ 70 years.

Primary closure versus T-tube drainage for calculus obstructive jaundice

Context Choledochotomy followed by T-tube has long been a standard surgical treatment for choledocholithiasis. Till now, it is the first choice in many hospitals where minimal invasive procedures are not feasible, although it has many complications. To avoid these complications, primary closure of the common bile duct (CBD) after exploration is performed. Aims This study aimed to assess the safety of primary closure of CBD, which would help for its implementation on a wider scale. Settings and design This randomized controlled trial was conducted in outpatient clinic of the Surgical Department, Faculty of Medicine, Sohag University Patients and methods A total of 50 patients were recruited from the outpatient clinic at Sohag University Hospital during the period from July 2019 to December 2020. They were randomly assigned into two groups: group A patients underwent CBD exploration with primary closure, and group B patients underwent CBD exploration with insertion of T-tube. Statistical analysis used Descriptive analysis (frequency, percentage, mean, and SD), χ2/Fisher’s exact test, and independent t test were applied. Results There was a significant difference between group A and group B cases regarding operative time and hospital stay. There was no significant difference between group A and group B cases regarding postoperative early and late complications. Conclusions Morbidity and length of hospital stay after primary closure of CBD after choledocholithotomy is significantly less compared with insertion of T-tube.

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

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.

Comparison of primary closure and T-tube drainage of the common bile duct after choledochotomy

The closure of common bile duct (CBD) after choledocholithotomy can be done over T-tube or primarily. The method of T-tube drainage comes with many complications and hence, nowadays, there is tendency to close CBD primarily which leads to less complications and shorter duration of stay at hospital. We conducted this study comparing primary closure of CBD with T-tube drainage following choledocholithotomy over a period of one year in 40 patients divided in two groups each of 20 i.e. Group A– primary closure and Group B- T-tube drainage. The results were compared in terms of operating time, duration of stay at hospital and complications such as leakage and wound infection. It was observed that primary closure group had less operating time, less duration of hospital stay and less complication rates as compared to T-tube group. Hence, we concluded in our study that primary closure can be recommended as safe alternative procedure after choledocholithotomy in selected patients of choledocholithiasis.

Management of common bile duct calculi in a tertiary care hospital in North East India

Background: Common bile duct calculi are frequently encountered in patients with cholelithiasis. Treatment ranges from endoscopic retrograde cholangiopancreatography (ERCP) to various surgical treatment modalities done either by laparoscopic or open techniques.Methods: This was a retrospective cross-sectional study carried out in General Surgery department of NEIGRIHMS Hospital from April 2014 to March 2020. Patients attending the hospital with choledocholithiasis during the time period have been included in the study.Results: A total of 82 patients were included in the study. The prevalence of common bile duct (CBD) calculi in patients attending NEIGRIHMS Hospital with symptomatic gallstone diseases was 5.16%. Treatments ranged from primary CBD closure or T-tube drainage after CBD exploration either by laparoscopic techniques, choledocho-duodenostomy and ERCP. Bile peritonitis in 9 patients and retained stone were observed in some patients who were managed accordingly. No mortality was seen in any patient.Conclusions: The number of patients with CBD calculi and symptomatic gallstone disease attending NEIGRIHMS Hospital is less and standard of care is provided to the patients with acceptable morbidity and mortality.

Long-term Outcomes Following Primary Closure of Common Bile Duct Following Laparoscopic Common Bile Duct (CBD) Exploration: Experience of 355 Cases at a Tertiary Care Center.

Primary closure of common bile duct (CBD) after laparoscopic common bile duct exploration (LCBDE) is now becoming the preferred technique for closure of choledochotomy. Primary CBD closure not only circumvents the disadvantages of an external biliary drainage but also adds to the advantage of LCBDE. Here, we describe our experience of primary CBD closure following 355 cases of LCBDE in a single surgical unit at a tertiary care hospital. All patients undergoing LCBDE in a single surgical unit were included in the study. Preoperative and intraoperative parameters including the technique of CBD closure were recorded prospectively. The postoperative recovery, complications, hospital stay, antibiotic usage, and postoperative intervention, if any, were also recorded. Three hundred fifty-five LCBDEs were performed from April 2007 to December 2018, and 143 were post-endoscopic retrograde cholangiopancreatography failures. The overall success rate was 91.8%. The mean operative time was 98±26.8 minutes (range, 70 to 250 min). Transient bile leak was seen in 10% of patients and retained stones in 3 patients. Two patients required re-exploration and 2 patients died in the postoperative period. Follow-up ranged from 6 months to 10 years, with a median follow-up of 72 months. No long-term complications such as CBD stricture or recurrent stones were noted. Primary closure of CBD after LCBDE is safe and associated with minimal complications and no long-term problems. The routine use of primary CBD closure after LCBDE is recommended based on our experience.

Laparoscopic Common Bile Duct Exploration With Primary Closure After Failed Endoscopic Retrograde Cholangiopancreatography Without Intraoperative Cholangiography: A Case Series from a Referral Center in Bogota, Colombia.

Background: Despite the effectiveness of laparoscopic common bile duct (CBD) surgery, no case series details the use and advantages of laparoscopic CBD exploration (LCBDE) without use of intraoperative cholangiography (IOC) in endoscopic retrograde cholangiopancreatography (ERCP) failure. Therefore, we present a case series regarding our success with LCBDE in managing CBD stones (CBDSs) using laparoscopic technique without IOC. Materials and Methods: We performed a descriptive retrospective observational study. Patients with CBDSs, alone or along with gallbladder stones, were treated through LCBDE with primary CBD closure after failed ERCP. Results: All patients underwent LCBDE with choledocotomy and primary duct closure. Patients with gallbladder stones underwent laparoscopic cholecystectomy (78%). All procedures were successful, and no conversions occurred. Surgery duration averaged 106 minutes. Intraoperative bleeding averaged 15 cc, and no mortalities occurred. No patients required additional surgery or intensive care unit admission. Hospitalization duration averaged 5 days. Conclusions: Therefore, a laparoscopic approach with primary CBD closure after failed ERCP for complex CBDSs is safe and effective.

2168 Type II Choledochal Cyst With Obstructive Jaundice and Chronic Pancreatitis: A Case Report

INTRODUCTION: Choledochal cysts are a rare congenital cystic dilation of the biliary tract and occur commonly in female infants and young children. Although rare in Western countries, choledochal cysts are more common in East Asian countries with Type II cysts accounting for only 2% of reported cases. We present an interesting case of a Type II choledochal cyst in a patient with chronic pancreatitis. CASE DESCRIPTION/METHODS: A 56 year old male presented with abdominal pain associated with nausea and non-bloody emesis. He also had reduced appetite, dark urine, and a 10 pound weight loss over several months. Physical examination revealed scleral icterus and epigastric abdominal tenderness. Laboratory investigations revealed mild leukocytosis (11.1), elevated total bilirubin (8.6), aspartate aminotransferase (77), alanine aminotransferase (128), and alkaline phosphatase (556). A CT with intravenous contrast (Figure 1) demonstrated coarse calcifications within the pancreas, a large cystic lesion within the head of the pancreas with marked pancreatic ductal dilation, atrophy, and intraductal calcifications. Gallbladder distension with sludge and upstream biliary dilatation was also noted. Endosonographic images (Figure 2) revealed an anechoic cystic lesion in the head of the pancreas with compression of the common bile duct (CBD). Fine needle aspiration was performed with aspirated fluid highly suggestive of bile. A cholangiogram confirmed the presence of an intrapancreatic cystic cavity in direct communication with the distal CBD in a diverticular configuration suggestive of a Type II choledochal cyst with narrowing of the adjacent CBD. A pancreatic sphincterotomy followed by pancreas stone lithotripsy and stone extraction was performed. A biliary stent was placed into the CBD. The patient tolerated the procedure well and was scheduled for multidisciplinary discussion pending brush cytology. DISCUSSION: Choledochal cysts are congenital anomalies which results in cystic dilation of the biliary tree. Adults are more likely to present with biliary or pancreatic symptoms whereas children present with an abdominal mass and jaundice. Malignancy is associated with Type I and IV cysts while Types II, III, and V cysts have minimal neoplastic risk. Treatment is based on the cyst type. Diverticulectomy of Type II choledochal cyst followed by primary CBD closure at the diverticulum neck is usually sufficient. A multidisciplinary approach may be warranted based on patient clinical status and co-morbidities.

Laparoscopic common bile duct exploration with primary closure is safe for management of choledocholithiasis in elderly patients

BackgroundLaparoscopic common bile duct exploration (LCBDE) is one of the minimally invasive options for choledocholithiasis. Primary closure of the common bile duct (CBD) upon completion of laparoscopic choledochotomy is safe in selected patients. The present study aimed to evaluate the feasibility and safety of primary closure of CBD after LCBDE in patients aged 70 years or older. MethodsA total of 116 patients (51 males and 65 females) who suffered from choledocholithiasis and underwent primary closure of the CBD (without T-tube drainage) after LCBDE from January 2003 to December 2017 were recruited. They were classified into two groups according to age: group A (≥70 years, n = 56), and group B (<70 years, n = 60). The preoperative characteristics, intraoperative details, and postoperative outcomes of the two groups were evaluated. ResultsThe mean operative time was 172.02 min for group A and 169.92 min for group B (P = 0.853). The mean hospital stay was 7.40 days for group A and 5.38 days for group B (P < 0.001). Bile leakage occurred in two patients in group A and one in group B (3.57% vs 1.67%, P = 0.952). There were no significant differences in the rates of postoperative complications and mortality between the two groups. At median follow-up time of 60 months, stone recurrence was detected in one patient in group A and two in group B (1.79% vs 3.33%, P = 1.000). Stenosis of CBD was not observed in group A and slight stenosis in one patient in group B (0 vs 1.67%, P = 1.000). ConclusionPrimary closure of the CBD upon completion of laparoscopic choledochotomy is safe and feasible in elderly patients ≥70 years old.

Safety of primary common Bile Duct Closure

Safety of primary common Bile Duct Closure

Human fibrin sealant reduces post-operative bile leakage of primary closure after laparoscopic common bile duct exploration in patients with choledocholithiasis.

Context:Primary closure of the common bile duct (CBD) without drainage is considered a suitable approach after laparoscopic CBD exploration (LCBDE); however, the risk of post-operative bile leakage is high. Up to now, it has not been clear whether human fibrin sealant can reduce post-operative bile leakage of the primary suture.Aims:In this study, we evaluated the role of human fibrin sealant in primary closure of the CBD after LCBDE.Subjects and Methods:Patients with choledocholithiasis who had undergone primary duct closure of the CBD after LCBDE were divided into two groups according to whether fibrin sealant was used.Statistical Analysis Used:Fisher's exact test or the Chi-square test was used for categorical variables to calculate frequencies and percentages between the groups. The Student's t-test was used to compare the means of the continuous variables between the groups.Results:The human fibrin sealant group had a lower rate of post-operative bile leakage compared to the other group (P < 0.05). There were no significant differences in additional parameters such as operative time, post-operative stay duration, time to drain removal, bile duct stenosis, acute allergic reaction and overall mortality.Conclusions:Human fibrin sealant can reduce post-operative bile leakage in primary closure of CBD after LCBDE in patients with choledocholithiasis.

Trans-T-tube Biliary Drainage; an Alternative Treatment Option for Intractable Postoperative Biliary Fistula after Choledochotomy

Introduction: Persistent biliary fistula after biliary operation is not common, but sometimes it is very difficult problem, especially in case of friable common bile duct (CBD). Herein, we report a case of intractable postoperative biliary leakage treated with trans-T-tube biliary drainage (TTBD). Method: A 65-years-old man visited because of CBD stone and multiple left intrahepatic bile duct (IHBD) stones. After the left hemihepatectomy and choledocholithotomy, primary closure of CBD was performed because there was endoscopic retrograde biliary drainage (ERBD) catheter inserted already. On postoperative day 7, covered stent insertion in right hepatic artery was performed due to bleeding from hepatic artery branch. On the 5th day after the intervention, bile leakage was observed from drain and re-operation was performed. There was necrosis of CBD wall around choledochotomy site and debridement and T-tube insertion was performed. Persistent bile leakage was observed with average amount of 500ml/day even though well-functioning T-tube until 30 days after re-operation. And two times of ERBD tries were failed. T-tube cholangiography revealed bile leakage from CBD more proximal portion to T-tube insertion site. A drainage catheter through T-tube was inserted with positioning the catheter tip in right IHBD. Result: Two days after the procedure of TTBD, the amount of bile from drain was dramatically decreased and the drain was removed after 6 days after TTBD. Four weeks after the TTBD, T-tube and TTBD catheter were removed without any problem. Conclusion: For intractable persistent biliary fistula after choledochotomy, TTBD could be considered for useful alternative treatment option.

Trans-T-tube biliary drainage; an alternative treatment option for intractable postoperative biliary fistula after choledochotomy

Introduction: Persistent biliary fistula after biliary operation is not common, but sometimes it is very difficult problem, especially in case of friable common bile duct (CBD). Herein, we report a case of intractable postoperative biliary leakage treated with trans-T-tube biliary drainage (TTBD). Methods: A 65-years-old man visited because of CBD stone and multiple left intrahepatic bile duct (IHBD) stones. After the left hemihepatectomy and choledocholithotomy, primary closure of CBD was performed because there was endoscopic retrograde biliary drainage (ERBD) catheter inserted already. On postoperative day 7, covered stent insertion in right hepatic artery was performed due to bleeding from hepatic artery branch. On the 5th day after the intervention, bile leakage was observed from drain and re-operation was performed. There was necrosis of CBD wall around choledochotomy site and debridement and T-tube insertion was performed. Persistent bile leakage was observed with average amount of 500ml/day even though well-functioning T-tube until 30 days after re-operation. And two times of ERBD tries were failed. T-tube cholangiography revealed bile leakage from CBD more proximal portion to T-tube insertion site. A drainage catheter through T-tube was inserted with positioning the catheter tip in right IHBD. Results: Two days after the procedure of TTBD, the amount of bile from drain was dramatically decreased and the drain was removed after 6 days after TTBD. Four weeks after the TTBD, T-tube and TTBD catheter were removed without any problem. Conclusion: For intractable persistent biliary fistula after choledochotomy, TTBD could be considered for useful alternative treatment option.

Efficacy of laparoscopic common bile duct exploration and primary duct closure in the treatment of choledocholithiasis

Objective To investigate the clinical efficacy and safety of laparoscopic common bile duct exploration and primary common bile duct closure in the treatment of extrahepatic bile duct calculi. Methods The clinical data of 215 patients undergoing laparoscopic common bile duct exploration from October 2010 to December 2016 in Wuxi Xishan People’s Hospital were retrospectively analyzed. According to the different surgical methods, patients were divided into two groups: laparoscopic common bile duct exploration and primary common bile duct closure group(primary duct closure group, n=122) and laparoscopic common bile duct exploration group(T-tube drainage group, n=93). Operation time, intraoperative blood loss, recovery time of gastrointestinal tract, liver function in postoperative 1 week and hospitalization expenses, postoperative hospital stay(t test) and postoperative complications(χ2 test) were compared. All patients were follow-up by clinic and telephone for 6 months. Measurement data were represented as (±s), and t test was used between the two groups, while count data using χ2 or Fisher test. Results The postoperative hospital stay in primary duct closure group and T-tube drainage group was(8.5±1.9) days and (12.5±2.4) days respectively, the difference between the two groups was statistically significant(P 0.05). There was no long-term complications in both groups after 6 follow-up months. Conclusion Under favorable operation technology and strictly grasp the surgical indications, laparoscopic common bile duct exploration and primary common bile duct closure has good clinical application value, and can embody minimally invasive and enhance recovery. Key words: Surgical procedures, minimally invasive; Choledocholithiasis; Laparoscopic surgery; Primary common bile duct closure; T tube drainage

Laparoscopic Exploration Can Salvage Recurrent Common Bile Duct Stone after Cholecystectomy

Conventionally, patients suffered from recurrent common bile duct (CBD) stone after cholecystectomy are suggested to be treated with endoscopic retrograde cholangiopancreaticography. This study was designed to explore the feasibility of laparoscopic common bile duct exploration (LCBDE) as a salvage procedure for recurrent CBD calculi after cholecystectomy. A retrospective review was conducted of data from 65 patients who underwent LCBDE for recurrent CBD calculi after cholecystectomy from January 2011 to July 2015. LCBDE was successfully carried out in 61 cases, with a successful rate of 93.8 per cent. Three cases required open conversion because of serious abdominal adhesion, and one case for intraoperative bleeding. Postoperative bile leakage occurred in two cases, and bile peritonitis developed in one case; all these three patients with complications were fully cured by conservative treatment. A postoperative retained CBD stone was found in one patient, which was extracted with endoscopic sphincterotomy. Furthermore, it was found that the mean operative time and length of postoperative hospital stay were much shorter in primary closure group (n = 49) than in T-tube drainage group (n = 12), and the hospital expense was also lower in primary closure group. We suggest that LCBDE could be a novel approach as a salvage procedure for the recurrent CBD stone after cholecystectomy, and we prefer to intraoperative primary closure of CBD if possible.

Primary closure versus T-tube drainage following laparoscopic common bile duct exploration in acute cholangitis cases

Objective To compare the clinical efficacy of primary closure versus T-tube drainage after laparoscopic common bile duct exploration in acute cholangitis cases. Methods The clinical data of 100 patients with acute cholangitis undergoing laparoscopic common bile duct exploration from January 2012 to December 2014 were reviewed. 54patients received primary closure of the common bile duct and 46 patients were subjected to T-tube drainage after choledochotomy. Results One hundred patients underwent the surgery successfully. Compared with the T-tube group, the operation time(96.72 min vs 123.00 min, P=0.001), intraoperative blood loss(27.13 ml vs 38.48 ml, P=0.009), postoperative gastrointestinal function recovery time(1.57 d vs 2.33 d, P=0.003) and postoperative hospital stay(6.19 d vs 9.20 d, P=0.000) were significantly less in the primary closure group. There were no statistical differences in the incidence of postoperative drainage(309.22 ml vs 212.46 ml, P=0.070), drainage time(3.96 d vs 4.02 d, P=0.875), incidence of bile leakage(9.3% vs 0, P=0.060) and postoperative bleeding rate(5.1% vs 2.2%, P=0.622) between these two groups. Conclusion Laparoscopic common bile duct exploration with primary closure of the common bile duct is an effective and safe procedure in acute cholangitis cases compared with T-tube drainage. Key words: Cholangitis, acute; Laparoscopic common bile duct exploration; Suture techniques; T-tube drainage; Feasibility studies

Appropriate Patient Selection Is Essential for the Success of Primary Closure After Laparoscopic Common Bile Duct Exploration.

Laparoscopic common bile duct exploration (LCBDE) is being increasingly used for management of common bile duct (CBD) stones. Primary CBD closure has been reported to have better short-term outcomes compared to T-tube placement. However, primary CBD closure cannot be performed in all patients. This study aims to evaluate the short- and long-term outcomes of LCBDE with primary CBD closure in appropriately selected patients and compare them with T-tube drainage. Retrospective analysis of patients undergoing LCBDE in our department from June 2011 to October 2014 was performed. Primary closure was performed in 52 patients (group A), and a T-tube was placed in 33 patients (group B). Patient demographics, intraoperative findings, postoperative stay, complications, and long-term follow-up data were recorded and compared. The mean operating time was much longer in group A compared to group B (113.92 vs. 95.92min, p=0.032). The overall complication rate (9.6 vs. 6.3%, p=0.701) and hospital stay (4 vs. 5.11days, p=0.088) were similar in both groups. No patient required conversion to the open procedure. Bile leakage was more frequent in group A (5.78 vs. 0%, p=0.279), but this was not statistically significant. All three patients with bile leakage were treated successfully by conservative measures and gradual drain withdrawal. On long-term follow-up, recurrent stones were detected in two patients in group A. No patient was found to develop CBD stricture. LCBDE and primary CBD closure has excellent short- and long-term outcomes when performed in appropriately selected patients.

Intraoperative endoscopic nasobiliary drainage over primary closure of the common bile duct for choledocholithiasis combined with cholecystolithiasis: a cohort study of 211 cases

Endoscopic nasobiliary drainage (ENBD) was often used for preoperative biliary drainage in cases like cholangiocarcinoma or acute obstructive suppurative cholangitis, reports on endoscopic nasobiliary drainage (ENBD) over primary closure of the common bile duct (CBD) are limited. This study compares outcomes of laparoscopic cholecystectomy (LC)+laparoscopic CBD exploration (LCBDE)+intraoperative ENBD+primary closure of CBD with equivalent patients who underwent preoperative endoscopic retrograde cholangiopancreatography (ERCP) and subsequent LC. From January 2013 to December 2015, 829 consecutive patients with choledocholithiasis combined with cholecystolithiasis underwent surgery in our department. 211 patients underwent LC+LCBDE+intraoperative ENBD+primary closure of CBD (group A) and 117 preoperative ERCP+subsequent LC (group B). A total of 501 patients (355 who underwent T-tube drainage and 146 who underwent transcystic exploration) were excluded from the analysis. Clinical records, operative findings, and postoperative follow-up were analyzed. Age and sex distribution, comorbidity, presentations, CBD diameter, and size and number of stones were similar in the two groups, and there was no postoperative mortality. Duration of surgery in group A was shorter (83 vs. 104min, P<0.01), as was postoperative hospital stay (6 vs. 9days, P<0.01). Average operative expenditure in group A was less than that of group B ($ 3816 vs. $ 4015, P<0.01). The success rate in group A was higher (100 vs. 91%, P<0.01). Ten patients in group B converted to LCBDE. The postoperative complication rate was higher in group B but without significant difference (1.9 vs. 4.2%, P=0.29). Median follow-up time was 24 (3-28) months (n=302 patients). Two patients in group B reported residual stones. LC+LCBDE+intraoperative ENBD+primary closure of CBD should have priority over preoperative ERCP+subsequent LC for choledocholithiasis combined with cholecystolithiasis.

Laparoscopic Management of Common Bile Duct Stones

Introduction: Common bile duct(CBD) stones are found in approximately 16% of the patients undergoing laparoscopic cholecystectomy (LC). Till recently, the gold standard for treating CBD stones wasendoscopic removal, if that failed, then open surgery. However, in the laparoscopic era, the besttreatment for CBD stones is a matter of debate and it continues to evolve. The objective of the presentstudy was to determine whether laparoscopic CBD exploration (LCBDE) is a safe, feasible and single-stageoption for the management of CBD stones. Patients and methods: All patients were done in our surgery department. Out of the 450 laparoscopiccholecystectomies between 2012-2015,we did selective intraoperative cholangiogram in 45 patients(10%) who were suspected to have CBD stones based on deranged liver function tests, dilated CBD with orwithout CBD stone on sonography or having the history of recent jaundice/ pancreatitis. If CBD stonewas found, either a transcystic or transcholedochal exploration was done depending on the size, site,number of stones and CBD diameter. Choledochotomy was closed over a t-tube in few numberof patients. Primary closure of CBD was done in the majorityof patients and in one patient we placed an antegradestent and in another one we placed endoscopic stent into the CBD laparoscpically which was removed afterfour weeks. Results: Till date we have performed LCBDE in 34 patients. Transcystic exploration wasdone in 10 patients and transcholedochal exploration was done in 20 cases out of which 2 patientshad minor biliary leak which settled on conservative treatment in 2-3 days. Four patients requiredconversion to open surgery as there were multiple stones. We did not have any major complication andon 6 months follow-up in 83.3% patients, none was found to have residual stones. Conclusion: Treatment of CBD stones depends on the resources available, technical limitations and the surgeon’sexpertise. Laparoscopic CBD exploration is a safe, feasible and single-stage option for the managementof CBD stones.

Laparoscopic common bile duct exploration for choledocholithiasis

Objective To assess the safety and efficacy of laparoscopic common bile duct (CBD) exploration for choledocholithiasis associated with cholelithiasis. Methods A retrospective study was conducted on all patients who underwent laparoscopic CBD exploration at the Affiliated Shantou Hospital of Sun Yat-sen University from January 2012 to December 2015. Their demographic, intraoperative, postoperative and follow-up data were analyzed. Results Of 376 patients who underwent laparoscopic CBD exploration, 339 patients had primary closure (the primary closure group) and 37 patients had T-tube drainage (the T-tube drainage group). The primary closure group was associated with a shorter operative time [(120.0±39.1) min vs. (165.8±49.9) min], hospitalization stay [(10.4±5.2) d vs. (14.8±6.0) d], postoperative intravenous infusion time [(4.5±2.8) d vs. (8.9±4.6) d], postoperative hospitalization stay [(5.1±3.2) d vs. (9.9±4.8) d], as well as a lower postoperative complication rate (3.2% vs. 16.2%) and a lower total hospitalization expenses [(20 334.1±8 013.2) ￥ vs. (23 762.0±6 776.4) ￥] when compared with the T-tube drainage group (P<0.05). T-tube drainage was frequently used in patients with a high total bilirubin, severe obstructive jaundice, biliary tract infection, and an obviously dilated common bile duct. Conclusions Laparoscopic CBD exploration was safe and feasible in treating choledocholithiasis associated with cholelithiasis. Laparoscopic CBD primary closure produced better results than T-tube drainage. Key words: Choledocholithiasis; Laparoscopic common bile duct exploration; Primary closure; T-tube drainage