Non-absorbable Thread Research Articles

Laparoscopic repair of a primary parahiatal hernia combined with gastric volvulus: a case report and literature review

BackgroundParahiatal hernias present a hernial orifice at the diaphragm that is adjacent to the esophageal hiatus, differing from the paraesophageal type of hiatal hernias. Although diagnostic imaging has advanced in recent years, diagnosing parahiatal hernias remains challenging. We herein report a case in which we performed laparoscopic surgery and intraoperatively diagnosed a parahiatal hernia.Case presentationA 67-year-old man presented to our hospital with difficulty eating, epigastric pain, and vomiting. We suspected a paraesophageal hiatal hernia. Laparoscopic surgery was performed, and a diagnosis of parahiatal hernia was made. We closed the hernial orifice with direct simple closure using nonabsorbable threads. The patient’s postoperative recovery course was reasonable, and he was discharged on the twelfth postoperative day.ConclusionsParahiatal hernias are rare, and a definitive diagnosis is difficult. Laparoscopic surgery can help accurately diagnose and treat patients presenting with the condition.

Thread Lifting Materials: A Review of Its Difference in Terms of Technical and Mechanical Perspective.

Thread lifting involves the use of slender materials, reminiscent of threads, for aesthetic procedures. These materials are distinct from traditional sutures and vary in composition, purpose, and performance. The introduction delves into the literal and material significance of threads, establishing the broad concept of thread lifting materials. The article revisits the evolution of thread lifting materials, emphasizing the preexistence of cog threads for tissue manipulation before their widespread adoption in plastic surgery. Observations regarding the efficacy and longevity of absorbable versus non-absorbable threads are discussed, stressing the efficiency of high-quality absorbable cog threads. The conclusion underlines the proliferation of thread lifting materials beyond PDO, highlighting the importance of considering multiple factors beyond duration when selecting threads for lifting procedures.

Status of clipless laparoscopic cholecystectomy in a tertiary care hospital of Nepal: A descriptive cross-sectional study

Background & Objectives: In this modern age, the preferred course of treatment for gallstone disease symptoms is laparoscopic cholecystectomy. For securing both the cystic duct and artery with a single ligation (SLAD), is a quicker and safe procedure. The study was aimed to determine the status of clipless laparoscopic cholecystectomy in a tertiary care hospital of Nepal. Materials and Methods: A total of 205 patients with gallstone, who underwent laparoscopic cholecystectomy at tertiary center of Nepal of age group 16 - 70 years were included. During the procedure the cystic duct and artery was tied with single ligation. Data were subjected to Microsoft excel 16 for analysis. Results: Laparoscopic cholecystectomy was performed in 205 patients with gallstone. Average age of patients was 31.54 yrs. There was female predominance in the study. The cystic duct and artery were tied in single ligature using nonabsorbable Silk 2-0. The mean time taken for ligation was 120.78 ± 26.92seconds. Bile leakage and intra-op bleeding were found in two patients without any mortality. Conclusion: In laparoscopic cholecystectomy, a viable and secure alternate technique for securing the cystic artery and duct is single ligation with the use of non-absorbable thread. Even though it is a common procedure, it has an additional benefit over clips when dealing with thick, edematous cystic artery and duct complexes. It lowers the threat of surgical morbidity and does not increase the intra operative time.

Revolutionizing thread lifting: Evolution and techniques in facial rejuvenation.

This review explores the utilization of thread lifting materials, distinct from traditional sutures, in aesthetic procedures. It aims to elucidate the varied composition, purpose, and performance of these slender materials. The article contextualizes thread lifting materials by exploring their literal and material significance. The evolution of these materials is traced, emphasizing the preexistence of cog threads for tissue manipulation before their widespread adoption in plastic surgery. Observations regarding the efficacy and longevity of absorbable versus non-absorbable threads are discussed, with a particular emphasis on the efficiency of high-quality absorbable cog threads. The proliferation of thread lifting materials extends beyond PDO, necessitating consideration of multiple factors beyond duration when selecting threads for lifting procedures. This underscores the importance of comprehensive evaluation in choosing appropriate thread lifting materials.

Thread lifting as a modern method of non-radical face rejuvenation

Purpose of the study: The purpose of this review of scientific literature is to collect, systematize and update modern ideas about the types, methods and principles of thread lifting, taking into account the basic requirements for efficiency and safety.In this paper, we reviewed publications presented in scientific databases: Web of Science, Scopus, PubMed, Cochran library, Medline, and PubMed Central. The keywords for searching for materials were: thread lift, thread lift history, thread lift sutures, face thread lift, polylactic threads, polydioxanone threads.The earliest approach to the effective use of thread rejuvenation techniques was the use of non-absorbable threads based on polypropylene, which are still successfully used along with modern threads, among which a special place is occupied by absorbable threads and new modifications of non-absorbable ones, complemented by various fixing design features (notches, cones).A large selection of threads, techniques and principles of correction allows specialists to create an individual management plan for each patient, and continuity and synergy between the sequential use of different modifications of threads allows one to prolong the results obtained and delay or refuse more radical anti-aging surgeries on the face.At the same time, as a result of the review of the scientific literature, no published studies were found on the comparative analysis of thread and surgical methods of rejuvenation, which requires further study.

What are the Consequences of Incorrect Handling in the Treatment of Blunt-Cut Lip Injuries?

This study aimed report two cases of blunt-cut lip injury which occurred in postoperatory dehiscence. Patients were referred to the emergence attendance and the clinical examination revealed extensive laceration on the upper and lower lips of both patients, highly contaminated with asphalt residue. The affected regions were properly cleaned with saline and antiseptic solution, and, under local anesthesia, suturing was performed in layers in the muscle and oral mucosa region with 4-0 resorbable thread and in the skin region with 6-0 non-absorbable thread. Patients presented different levels of dehiscence on post-operatory evaluation. Thus, it was prescribed antibiotic and healing ointments for decontamination and improvement of the healing process. Third days post-operatory one of the patients presented a great healing of external lips and vermilion lip. However, the other patient presented aesthetic sequelae in the vermilion region of the lip, with a line of fibrosis and misalignment in the region, but not function sequelae. Thus, it was concluded that blunt injuries on the lip must strictly follow the established treatment protocols and must begin aiming for favorable results in the first intervention. Moreover, the postoperative care of the patient and the surgeon are as important as the procedure itself.

Drawbacks and Limitations of Thread Rhinoplasty.

Nonsurgical rhinoplasty using barbed threads has gained popularity in Asia as a result of being viewed as a minimally invasive procedure that is relatively inexpensive with a short recovery period and minimal complications. Usually, absorbable polydioxanone thread is used, but nonabsorbable thread is also sometimes used. When inserted, multiple barbs along the threads hook into the tissue, causing traction or stretching. Although minor tip projection or dorsal lengthening can be obtained simply using this procedure, it is difficult to increase volume sufficiently; therefore, the procedure is often combined with filler injection or fat grafting. However, the long-term benefit is questionable, since the filler is absorbed and fat is also partially absorbed over time.

Mesentero-axial gastric volvulus treated with laparoscopic gastropexy: a case report

BackgroundMesentero-axial gastric volvulus (MAGV) is an uncommon subtype of gastric volvulus (GV). However, reports of such cases in adult patients are very rare. We present an unusual case of idiopathic MAGV in an old woman.Case presentationAn 84-year-old woman was referred to the emergency department for vomiting and abdominal pain. An abdominal computed tomography scan revealed a mesentero-axial gastric volvulus, which could be corrected endoscopically, and the symptoms were relieved. Contrast-enhanced examination was performed before the elective surgery to confirm the presence of short-axis dorsal 180-degree volvulus. The patient underwent laparoscopic surgery on a wait-and-watch basis. After releasing the torsion, the stomach returned to normal position. The gastric fornix was sutured to the left diaphragm and the gastric body and antrum were sutured to the abdominal wall using non-absorbable thread. Symptoms did not flare after the surgery.ConclusionsWe experienced a rare case of adult MAGV presenting with incomplete obstruction. Laparoscopic gastropexy is useful when gastric decompression is achieved.

The Lichtenstein technique is being used adequately in inguinal hernia repair: national analysis and review of the surgical technique.

it is estimated that approximately 20 million people undergo inguinal hernia surgery annually in the world, with the Lichtenstein technique being the most performed surgical procedure. The objective of this study is to analyze the knowledge of the technical principles used in the Lichtenstein technique. Survey-type intersectional study approved by the research ethics committee of São Camilo University Center (CAAE: 70036523.1.0000.0062). During the research period, 11,622 e-mails were sent to members of the main national surgical societies with research on the technical principles of Lichtenstein surgery. The survey was carried out using an electronic form with 10 multiple-choice questions. The form was answered anonymously on the SurveyMonkey and Google Forms platforms. 744 responses were received to the electronic form. Based on this number of respondents, our survey has a confidence level of 95% with a margin of error of 3.5%. It was observed that there is no standardization of the technique among the majority of responders (53.4%). Many surgeons still perform digital dissection of the spermatic cord (47%). A small number of interviewees (15.2%) performed sutures with absorbable thread in the region of the internal oblique aponeurosis, while more than half (55.2%) continued to perform sutures with non-absorbable thread. Most surgeons use a small overlap or fix the mesh juxtaposed to the pubic symphysis (51%). Our research identified that a small percentage of respondents adequately know the technical principles of Lichtenstein surgery. The result brings us new insights into the need to review Lichtenstein technique.

Mesh erosion into the rectum after laparoscopic posterior rectopexy: A case report

IntroductionRectal prolapse typically presents in elderly women with protruding full-thickness rectum from the anus. Rectopexy using mesh is known to be a highly curative treatment for rectal prolapse, however, this procedure carries the risk of severe complication as mesh erosion.Presentation of caseA 78-year-old woman who had undergone laparoscopic posterior rectopexy 4 years earlier visited the outpatient clinic with a complaint of bloody stool. A colonoscopy and computed tomography revealed that part of the mesh had migrated into the rectal lumen at 8 cm from the anal verge. Based on the above findings, a diagnosis of mesh erosion into the rectum was made. Complete removal of the mesh and tacker with rectal resection was performed. Before rectopexy, the patient had severe fecal incontinence, and her anal sphincter function was decreased, therefore, Permanent colostomy was indicated instead of anastomosis. In the resected specimen, the mesh was folded and placed in the mesenteric fat of the posterior wall of the rectum, with the corner of the edge of the mesh protruding into the inside lumen.DiscussionMesh erosion typically occurs when using mesh made of synthetic mesh and non-absorbable threads; it might induce chronic irritation and friction due to mesh shrinkage.ConclusionTo prevent mesh erosion, it is important to pay attention to the mesh materials used and ensure secure fixation.

Management of testicular torsion by a general surgeon isolated in Africa

RésuméL’apparition d’une douleur scrotale brutale et intense pose plusieurs problèmes quand elle survient chez un homme jeune en Afrique. Parmi les étiologies possibles, la torsion testiculaire est l’urgence chirurgicale à écarter, car au-delà de 6 heures d’évolution le pronostic fonctionnel du testicule est engagé. L’évolution septique vers une fonte purulente, en cas de torsion dépassée, est aussi possible. D’incidence légèrement inférieure à celle des pays occidentaux, la méconnaissance de cette pathologie par les acteurs de santé de proximité, la précarité ou l’isolement sanitaire de certaines populations dans certaines régions sous-médicalisées, contribuent aux retards diagnostique et thérapeutique. Cela conduit souvent à une évolution péjorative, la perte du testicule étant directement corrélée au délai de prise en charge. La torsion testiculaire a ainsi été identifiée comme l’une des principales causes d’infertilité masculine en Afrique. Pourtant, le diagnostic clinique et le traitement chirurgical nécessitent peu de moyens et restent accessibles dans un milieu à faibles ressources ou en conditions précaires. Cet article reprend le tableau clinique de torsion du cordon spermatique et la technique d’orchidopexie.

Congenital pyriform sinus fistula in a child: Transoral semiconductor laser cauterization and closure by nonabsorbable suture using the ORBEYE exoscope

Pyriform sinus fistula (PSF) is a congenital disease derived from the remnants of the third or fourth branchial cleft. Until now, open neck surgery has been the main curative treatment, but recent years have seen reports of cases treated using endoscopic oral fistulectomy, chemocauterization, or ablation. We used the ORBEYE 4K 3-dimensional surgical microscope system (Olympus, Japan) to cauterize the fistula cavity with a semiconductor laser and to close the fistula opening with a monofilament non-absorbent thread. The use of the ORBEYE exoscope, with which a good view of the surgical field can be shared with all surgical staff, and which provides a sufficient working space, has rarely been reported for PSF surgery, but indications for PSF cases are expected to increase in the future with the adoption of such methods. In addition, laser ablation of the fistula lumen alone poses an initial risk of influx of infection sources after surgery, so closure of the opening with nonabsorbable thread was considered important for improving curability. •Some kinds of transoral treatment for pyriform sinus fistula have been reported. •Transoral laser surgery using ORBEYE is proved to be a useful method. •Closure of the opening with nonabsorbable suture can suppress the recurrence.

Laceración perineal en una oveja Texel: reporte de un caso

The perineal laceration is one of the most common injuries related to the parturition, mostly in the equine specie, and, less frequently, in the bovine species. This disease is uncommon in ovine, therefore justifying the importance this case report. The present work aimed to present a case report of a third-degree laceration in a Texel breed ewe. Where received at the Veterinary Clinics School of the UNICENTRO, a Texel ewe, primiparous, 1.5 year of age, with historic of laceration during the birth of an only male lamb with 4,5kg. During the physical examination, all parameters were normal, but the laceration involved the dorsal commissure of the vulva, anal sphincter and a small portion of the vestibule. The preconized treatment was the immediate surgical intervention, once the animal was recent lambed and still not yet developed an intense local edema. Due the lesion at rectum and vestibule, were performed an epidural and infiltrative local anesthesia with lidocaine 2%. The vaginal vestibular mucosa suture pattern was Cushing, using an absorbable thread n.0. To the vulva reconstruction was necessary the resection of a segment of the mucous-cutaneous junction of each vulvar lip, followed by a single point suture, using a non-absorbable thread n.2-0. At the postoperative were administered sulfa + trimetoprim (15mg/kg, IM, SID) during seven days, and flunixin meglumine (1.1mg/kg, IM, SID) for three days. Daily wound cleaning was performed using povidine iodine diluted in NaCl 0.9% solution, finishing with a fly repellent around the perineal region. The suture was removed after 10 days, with the complete wound healing. Despite the successful surgery treatment outcome, the owner decided to discard the ewe after the lamb weaning.

A Meta-Analysis and Systematic Review of the Incidences of Complications Following Facial Thread-Lifting.

Facial thread-lifting (FTL) has gained more popularity, but the incidences of complications following FTL remain controversial. We aimed to perform a meta-analysis and systematic review to estimate the incidences of complications and to compare the short- and long-term satisfaction rates following FTL. We searched PubMed, Web of Science, Embase and Cochrane library for eligible studies. The primary outcome was the incidences of complications following FTL. The secondary outcome was the satisfaction rate immediately and 6-month after FTL. The pooled incidences of complications and 95% confidence intervals were estimated using random-effects models. A total of 26 studies were included in this meta-analysis. Swelling was the most commonly reported complication with a pooled incidence of 35%, followed by skin dimpling (10%), paresthesia (6%), thread visibility/palpability (4%), infection (2%), and thread extrusion (2%). Absorbable threads were associated with a significantly lower risk of paresthesia (3.1% vs. 11.7%) and thread extrusion (1.6% vs. 7.6%) than non-absorbable threads. Patients older than 50 years had a significantly higher risk of dimpling (16% vs. 5.6%) and infection (5.9% vs. 0.7%) than their younger counterparts. In addition, the pooled long-term satisfaction rate was significantly decreased compared to it immediately after FTL (88% vs. 98%). Non-absorbable threads and older age of patients are associated with higher risks of complications. Therefore, we recommend a judicious use of non-absorbable threads and FLT in older patients. Furthermore, it should be discussed with patients preoperatively that the rejuvenation effect of FTL may not maintain in the long-term. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

HIGH-RESOLUTION ULTRASOUND OF COSMETIC THREADS AFTER THEIR IMPLANTATION INTO THE SOFT TISSUES OF THE FACE AND NECK

Objective To optimize the process of diagnostics of cosmetic threads using the high-resolution ultrasound. Material and Methods 80 women were examined with high-resolution ultrasound after implantation of cosmetic threads made of absorbable and non-absorbable materials into the soft tissues of the face and neck. Threads based on the L-lactide-co-ԑ-caprolactone were implanted in 36 cases (45%), threads produced from silicone-sheathed polyester fiber were used for 7 (8.8%) patients, from polydioxanone for 17 (21.2%) patients, from L-lactic acid for 14 (17.5%) patients, polypropylene threads were implanted in 5 (6.3%) patients, gold threads were applied only in one case (1.2%). Patients complained of overcorrection in 10 cases, inflammatory complications in 10 cases as well, and inquired about the presence of the threads in soft tissues in 60 cases. Results Ultrasound feature of non-absorbable threads made of silicone-sheathed polyester fiber is a heterogeneous structure with a hypoechoic center and hyperechoic margins. Inflammation around the threads is accompanied by perifocal edema in the form of a zone of reduced echogenicity. The presence of an acoustic shadow is a differential feature that distinguishes threads from the ligamentous apparatus of the skin. Effect of reverberation is a specific feature for metal threads. Conclusion If threads are found in the implantation area, it is necessary to carry out differential diagnostics of the ligamentous apparatus, septa, and superficial fascia of the face. The methodological features lied in the fact that ultrasound diagnostics should be performed in multiple views with necessary visualization in the transverse and longitudinal sections of the studied object using the high-frequency sensors in B-mode, as well as the Doppler technology and compression elastography.

Sacrospinous Fixation in the Gynecology Department of Hôpital du Mali

Sacrospinous fixation (SSF) or Richter’s intervention (RI) aims to treat genital prolapse by securing the posterior vaginal wall to the small sacrospinous ligament. It is performed by low approach and includes a dissection of the pararectal space, visual exposure of the sacrospinous ligament and a needle with strait needle holder with nonabsorbable threads. It is often associated with a more complex corrective procedure, including cystocele cure, vaginal hysterectomy and posterior myorrhaphy. The objective of this study is to report the results of SSF in the gynecology department of Hopital du Mali. A descriptive study was conducted from September 2014 to September 2015 concerning 37 patients operated on for uterine prolapse (UP). All patients with grade III UP were included in our study in whom a unilateral hysterectomy (UH) and sacrospinous fixation (SSF) were performed. All the patients were scheduled. Preoperatively they had benefited from an assessment and a pre-anesthetic consultation. Hospitalization of at least 24 hours prior to the operation was required. Postoperative follow-up was two years with a physical examination at 3 months, 9 months and 15 months, and phone calls between physical consultations. During the study period, we performed 37 RIs. The mean age of the patients was 48 years with extremes of 41 to 73 years. The large multiparity was found out in 35 cases (94.59%), the pauciparous were two with 3 deliveries for each. Long labor of more than 18 hours was found out in 9 patients (24.32%) and home delivery in 13 cases (35.13%). The duration of the occurrence of prolapse was at least two years and 35 patients were going through menopause. The type of anesthesia used for the surgery was spinal anesthesia for all patients. The average duration of the operation was 90 minutes. Complications occurred in three patients or 8.10% of cases, two cases of acute urine retention and one case of hematoma of the para-rectal space. The medium time of hospital stay was 5 days. The anatomical result was satisfactory in all patients. However, two patients presented with grade II rectocele one year after the operation. Sacrospinous fixation is a technique suitable for our patients who present with genital prolapse with extreme laxity of the suspension ligaments. Well done, it brings anatomical satisfaction and its complications are rare and slight.

Gastric volvulus with perforation 1 year after total pancreatectomy: a case report

BackgroundBecause of its rare indication and relatively simple reconstruction procedure (only choledochojejunostomy and gastrojejunostomy) compared to those for pancreatoduodenectomy, the technical tips and pitfalls of total pancreatectomy are rarely discussed. Herein, we discuss a rare case of gastric volvulus 1 year after total pancreatectomy and provide advice to prevent such cases.Case presentationA 66-year-old woman underwent total pancreatectomy with splenectomy for mixed-type intraductal papillary mucinous neoplasm of the pancreas. Choledochojejunostomy (retro-colic route) and gastrojejunostomy (ante-colic route, Billroth II method) were performed for reconstruction. The final diagnosis was mixed-type intraductal papillary mucinous adenoma of the pancreas without malignant neoplasm. She had no clinical symptoms, such as abdominal pain and fever, during postoperative follow-up. However, at 1 year postoperatively, she complained of abdominal pain. Contrast-enhanced abdominal computed tomography showed volvulus and perforation of the stomach. Emergent surgery was performed. The stomach fornix was located on the right side and was partly perforated. We resected the perforation site with a linear cutter® (New Type Linear Cutter, Ethicon, USA) and released the gastric volvulus. Moreover, we fixed the stomach to the left abdominal wall using non-absorbable thread. The cause of the perforation was clinically and pathologically unclear. Her serum albumin and cholinesterase levels temporarily decreased postoperatively, but gradually increased. A recurrence of volvulus-related symptoms has not been observed.ConclusionsAfter total pancreatectomy with splenectomy, although the stomach is connected with the jejunum, it is typically fixed only by the pedicle of the left gastric artery and vein. In the present case, this anatomical change may have been a cause of the gastric volvulus. Thus, it might be better to fix the remnant stomach in total pancreatectomy with splenectomy.

Thread Lifts: A Critical Analysis of Treatment Modalities.

Background: Thread lifting procedure was developed to reverse the aging process and restore youthful appearance by retightening and lifting the skin. Different models of absorbable and non-absorbable threads are universally available and promise quick results with minimum downtime. Objectives: To evaluate the efficacy, safety, and cost effectiveness of the commonly used threads for facial lifting and rejuvenation using an evidence-based review. Methods: A comprehensive search of the literature was done using numerous databases (including Cochrane Collaboration, PubMed, Ovid, and Google Scholar). Thread lift for non-aesthetic purpose, open surgical procedure, animals or cadaver studies were excluded. 16 relevant studies were included. The extracted data included significant details related to the review question. Results: Several types of threads with different designs and properties are available for facial rejuvenation, provided by many companies all over the world. Higher quality evidence was found for Contour thread (III). Available studies for the other various threads were level IV. Thread lifting procedure was found to be safe and effective, with minor and mostly self-limited complications. The longevity of results varied from months to years, with more focus related to the technique and patient selection rather than the type of thread. Conclusion: Comparatively high quality long-term multicentre standardized studies are required to help aesthetic doctors to choose the appropriate thread type based on optimum aesthetic outcomes. J Drugs Dermatol. 2020;19(4):413-417. doi:10.36849/JDD.2020.3646.

Стабилизация грудинно-реберного комплекса при обширных флотирующих переломах ребер у детей: обзор литературы и собственный опыт

Thoracic injury is the leading cause of fatal complications. The incidence of chest trauma remains high. There are many fixation methods of the floating ribs of thoracic cage, which are technically challenging and linked to various materials. Objective: to search options for the sternocostal complex stabilization without the expenditures for manufacturing customised devices; to describe and implement the rib cage fixation method for floating fractured ribs in severely injured children, which is used by paediatric surgeons in Tyumen. Material and methods. In the south of the Tyumen Region for the period of 2016–2018, an original method of fixing the thoracic cage with multiple floating fractured ribs by means of a V-shaped modelled Cramer’s wire splint to extend the area of contact with the rib cage was used in four patients aged from 9 to 17 years. The splint was sutured with non-absorbable threads to the edges of stable parts of the ribs and to unstable segment of the rib cage, followed by its external fixation. Results. Having applied this method, it was possible to reliably, minimally invasively stabilize the rib cage in patients, achieve early spontaneous breathing, which reduced the length of stay in the intensive care unit. No purulent septic complications were observed. Conclusions. The proposed restoration method of skeletal function of the chest by using the external fixation with a V-shaped Cramer’s wire splint is simple and acceptable in any hospital.

Clinical efficacies of free endoscopic nasobiliary drainage in primary duct closure following laparoscopic common bile duct exploration: a multicenter retrospective study (A report of 312 cases)

Objective To investigate the clinical efficacies of free endoscopic nasobiliary drainage (ENBD) in primary duct closure (PDC) following laparoscopic common bile duct exploration (LCBDE) for choledocholithiasis. Methods The retrospective cohort study was conducted. The clinical data of 312 patients with extrahepatic bile duct stones accompanied with or without cholecystolithiasis who were admitted to the 11 medical centers [86 in the Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 62 in the Second Affiliated Hospital of Zhejiang University School of Medicine, 44 in the West China Hospital of Sichuan University, 29 in the First Affiliated Hospital of Xi′an Jiaotong University, 27 in the First Hospital Affiliated to Army Medical University (Third Military Medical University), 25 in the Hunan Provincial People′s Hospital, 17 in the Beijing Friendship Hospital of Capital Medical University, 10 in the First Affiliated Hospital of Hainan Medical University, 5 in the Henan Provincial People′s Hospital, 4 in the Beijing Tian Tan Hospital of Capital Medical University, 3 in the First Affiliated Hospital of Fujian Medical University] from January 2011 to June 2017 were collected. All patients underwent LCBDE+ PDC, and 81 and 231 patients with and without ENBD were respectively allocated into the ENBD group and PDC group. Observation indicators: (1) comparisons of operation situations; (2) comparisons of postoperative recovery; (3) comparisons of postoperative complications; (4) follow-up situations. Follow-up using outpatient examination and telephone interview was performed to detect the postoperative complications up to June 2017. Measurement data with normal distribution were represented as ±s. Comparison between groups was analyzed by the t test. Measurement data with skewed distribution were represented M [interquartile range (IQR)], and comparison between groups was analyzed by the nonparametic test. Comparisons of count data were analyzed using the chi-square test and Fisher exact probability. Results (1) Comparisons of operation situations: all the 312 patients underwent successful laparoscopic LCBDE + PDC, without conversion to open surgery, including postoperative death of 1 patient in the PDC group. The common bile duct diameter, cases using interrupted sutures, continuous sutures, absorbable threads and non-absorbable threads were respectively (1.2±0.4)cm, 106, 125, 195, 36 in the PDC group and (1.1±0.5)cm, 76, 5, 79, 2 in the ENBD group, with statistically significant differences between groups (t=2.497, χ2=56.706, 8.457, P 3 mm), normal and abnormal Oddi sphincter contraction function, volume of intraoperative blood loss and operation time were respectively 2.1±1.7, (1.1±0.6)cm, 148, 83, 226, 5, 20 mL (10-45 mL), (116±49)minutes in the PDC group and 1.9±1.6, (1.0±0.6)cm, 49, 32, 75, 6, 20 mL (15-30 mL), (113±23)minutes in the ENBD group, with no statistically significant difference between groups (t=1.021, 0.329, χ2=0.329, 3.428, Z=1.147, t=0.521, P>0.05). The further analysis: of 312 patients, cases and time using interrupted sutures and continuous sutures were respectively 182, 130 and (133±49)minutes, (103±34)minutes, with a statistically significant difference between groups (t=-6.605, P 0.05). Of 312 patients, cases, operation time, volume of intraoperative blood loss and postoperative complications using absorbable threads and non-absorbable threads were respectively 274, (116±44)minutes, 20 mL (15-40 mL), 33 and 38, (115±35)minutes, 18 mL (10-26 mL), 6, with no statistically significant difference between groups (Z=0.971, t=0.023, χ2=0.154, P>0.05). (2) Comparisons of postoperative recovery: recovery time of gastrointestinal function, time of abdominal drainage-tube removal, using time of antibiotics and duration of hospital stay were respectively (2.0±1.5)days, (4.0±2.4)days, (4.0±2.8)days, (5.5±3.0)days in the PDC group and (4.0±1.9)days, (6.9±3.5)days, (10.0±3.9)days, (11.1±3.7)days in the ENBD group, with statistically significant differences between groups (t=-9.507, -8.258, -15.103, -13.575, P 0.05). (4) Follow-up situations: of 312 patients, 252 were followed up for 2-67 month, with a median time of 15 months, including 175 in the PDC group and 77 in the ENBD group. During the follow-up, there was no occurrence of jaundice, cholangitis and pancreatitis, and stone recurrence and postoperative cholangiostenosis were not detected by abdominal color Doppler ultrasound or CT or magnetic resonanced cholangio-pancreatography. Conclusion On the basis of grasping operative indication strictly, ENBD in PDC following LCBDE for choledocholithiasis is safe and effective. Key words: Choledocholithiasis; Common bile duct exploration; Primary duct closure; Laparoscopy; Endoscopic nasobiliary drainage; Multicenter; Retrospective study