Laparoscopic Common Bile Duct Exploration with Primary Closure for Management of Choledocholithiasis: A Retrospective Analysis and Comparison with Conventional T-tube Drainage

2014 ◽  
Vol 80 (2) ◽  
pp. 178-181 ◽  
Author(s):  
Hong-Wei Zhang ◽  
Ya-Jin Chen ◽  
Chang-Hao Wu ◽  
Wen-Da Li
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Hospital Stay ◽  
Primary Closure ◽  
Bile Leakage ◽  
Common Bile Duct Exploration ◽  
Tube Drainage ◽  
T Tube ◽  
Group A ◽  
Group B

Laparoscopic common bile duct exploration (LCBDE) had become one of the main options for management of choledocholithiasis. This retrospective comparative study aimed to evaluate on the feasibility and advantages of primary closure versus conventional T-tube drainage of the common bile duct (CBD) after laparoscopic choledochotomy. In this retrospective analysis, 100 patients (47 men and 53 women) with choledocholithiasis who underwent primary closure of the CBD (without T-tube drainage) after LCBDE (Group A) were compared with 92 patients who underwent LCBDE with T-tube drainage (Group B). Both groups were evaluated with regard to biliary complications, hospital stay, and recurrence of stones. The mean operation time was 104.12 minutes for Group A and 108.92 minutes for Group B ( P = 0.069). The hospital stay was significantly shorter in Group A than that in Group B (6.95 days and 12.05 days, respectively; P < 0.001). In Group A, bile leakage occurred in two patients on postoperative Day 2 and Day 3, respectively. In Group B, bile leakage noted in one patient after removal of the T-tube on Day 14 after operation ( P = 1.000). With a median follow-up time of 40 months for both groups, stone recurrence was noted in two patients in Group A and three patients in Group B ( P = 0.672). Primary closure of the CBD is safe and feasible in selected patients after laparoscopic choledochotomy. It results in shorter duration of hospital stay without the need for carrying/care of a T-tube in the postoperative period and similar stone recurrence as that of the conventional method.

Primary Closure Versus T-Tube Drainage Following Laparoscopic Common Bile Duct Exploration in Patients With Previous Biliary Surgery

2020 ◽  
pp. 000313482094739
Author(s):  
Wan Zhen ◽  
Wang Xu-Zhen ◽  
Fu Nan-Tao ◽  
Li Yong ◽  
Xiao Wei-Dong ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Primary Closure ◽  
Common Bile Duct Exploration ◽  
Biliary Surgery ◽  
Tube Drainage ◽  
T Tube ◽  
Significant Difference ◽  
Group A ◽  
Group B

Laparoscopic common bile duct exploration (LCBDE) has been recently introduced for management of CBD stone in patients with previous biliary surgery history. The aim of this study was to evaluate the safety and effectiveness of primary closure in patients with previous biliary surgery history compared to T-tube drainage. Eighty patients with previous biliary surgery history including laparoscopic cholecystectomy, open cholecystectomy, or open common bile duct exploration were enrolled in the retrospective study. The patients were divided into 2 groups according to the methods of choledochotomy closure. Group A: patients with primary closure after LCBDE (n = 51); group B: patients with T-tube drainage after LCBDE (n = 29). Group A exhibited a shorter postoperative hospital stay and lower hospitalization expenses compared to group B. There was no significant difference in conversion rate to open surgery, operating time, intraoperative blood loss, bile leakage rate, overall complication rate, and stone recurrence rate between the 2 groups. Biliary stricture was not observed in the 2 groups during the follow-up period. Primary closure following LCBDE is safe and effective for the management of CBD stones in patients with previous biliary surgery history.

scholarly journals Primary closure of common bile duct versus T-tube placement after open choledocholithotomy

2020 ◽  
Vol 7 (6) ◽  
pp. 1951
Author(s):  
Manoj Seervi ◽  
Deepak Verma ◽  
Nemi Chand ◽  
Sarthak Sharma
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Primary Closure ◽  
Common Bile Duct Exploration ◽  
Biliary Stent ◽  
Tube Placement ◽  
Tube Insertion ◽  
T Tube ◽  
Endoscopic Extraction ◽  
Group B

Background: Choledocholithiasis is primarily managed by endoscopic retrograde cholangiopancreatography (ERCP) but in certain situation particularly large and impacted common duct stone, the procedure may not succeed and this small group of patients require either open or laparoscopic common bile duct exploration followed by T-tube insertion. Usually T-Tube cholangiogram is performed on 10th postoperative day and tube is removed on 12-14th day. Alternatively, primary closure of duct after post exploratory choledochoscopy to ensure duct clearance with or without biliary stent can be done.Methods: This study was performed on 25 patients of failed endoscopic extraction, subjected to open choledocholithotomy. Group A (n=7) had T-tube insertion whereas group B (n=18) had primary closure of duct after choledochotomy.Results: 19 patients had calculus cholecystitis whereas 6 patients had prior cholecystectomy and later developed choledocholithiasis. 52% patients had impacted stone and 40% had large stone as a cause of ERCP failure. Postoperative pyrexia, cholangitis, septicemia, sub-hepatic bilious drainage and postoperative hospital stay was higher in T-tube group as compared to primary closure group.Conclusions: Primary closure over the biliary stent after cholecystectomy and/or choledocholithotomy has less morbidity as compared to T-tube insertion and hence should be preferred choice in choledocholithiasis, provided stone free duct is ensured peroperative using choledochoscopy.

scholarly journals Primary closure versus T-tube drainage after laparoscopic choledocholithotomy: a prospective randomized study

2017 ◽  
Vol 4 (5) ◽  
pp. 1762 ◽  
Author(s):  
Jugendra Pal Singh Shakya ◽  
Neelabh Agrawal ◽  
Arun Kumar ◽  
Archana Agrawal ◽  
Akash Singh ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Primary Closure ◽  
Randomized Study ◽  
Tube Placement ◽  
Tube Drainage ◽  
Operative Complication ◽  
T Tube ◽  
Duration Of Hospital Stay ◽  
Group A ◽  
Group B

Background: Traditionally laparoscopic common bile duct exploration is followed by T-tube placement because of which patients suffer problems related to T-tube thereby increasing the morbidity of patients. Primary closure of CBD following laparoscopic choledocholithotomy is now being considered as an alternative superior to the traditional method. This study is designed to analyse the outcome of primary CBD repair in terms of mean operation time, duration of hospital stay and post-operative morbidity.Methods: A prospective randomized study was done in which 40 patients at our institute and associated hospitals were divided into two groups to compare the results of primary closure to T-tube placement following laparoscopic choledocholithotomy.Results: 40 patients were included in this study. The mean operating time was observed to be 65±14.05 mins in Group A (primary closure) patients while that in case of Group B (T-tube drainage) patients was 95.25±9.66 mins with a p-value 0.0001 which is considered statistically significant. The average duration of hospital stay in Group A (primary closure) was 8.2 days which was much shorter than that of Group B (T-tube drainage) patients which was of 15.7 days. The post-operative complication was observed in 1 patient of Group A (primary closure) while post-operative complication occurred in 3 patients of Group B (T-tube drainage).Conclusions: This study indicates that primary repair following laparoscopic choledocholithotomy is a safer and more effective method than T-tube drainage and we strongly recommend this procedure in clinical practice.

scholarly journals Primary Closure of the Duct Following Common Bile Duct Exploration in Choledocholithiasis. A Comparison between T-tube Drainage and RTBD-tube Drainage.

1993 ◽  
Vol 26 (8) ◽  
pp. 2160-2165
Author(s):  
Toshiomi Kusano ◽  
Norihiko Okushima ◽  
Masahito Yamazato ◽  
Shigeru Deguchi ◽  
Satoshi Tamaki ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Primary Closure ◽  
Common Bile Duct Exploration ◽  
Tube Drainage ◽  
T Tube
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