Application value of laparoscopic common bile duct re-exploration with primary closure for common bile duct stones

Objective To investigate the clinical application value of laparoscopic common bile duct re-exploration with primary closure for common bile duct stones. Methods Clinical data of 58 patients with common bile duct stones who underwent laparoscopic common bile duct re-exploration in the Affiliated Yixing Hospital of Jiangsu University between January 2011 and January 2015 were retrospectively analyzed. According to the different treatments after laparoscopic common bile duct re-exploration, the patients were divided into the primary closure group (closure group, n=28) and T tube drainage group (drainage group, n=30). In the closure group, there were 12 males and 16 females with a mean age of (49±11) years old. In the drainage group, there were 17 males and 13 females with a mean age of (52±11) years old. The informed consents of all patients were obtained and the local ethical committee approval was received. Peritoneal adhesion was separated sharply and bluntly by ultrasound scalpel and coagulation hook. The sub-hepatic space was exposed, a 0.5-cm incision in the anterior wall of common bile duct was made, and choledochoscope was put inside for exploration and lithotomy. After all common bile duct stones were removed, primary common bile duct closure or T tube drainage was performed. Hospitalization expense and postoperative length of hospital stay in two groups were compared using t test. And the rate was compared using Chi-square test. Results The hospitalization cost and postoperative length of hospital stay in the closure group was respectively (1.19±0.06)×104 yuan and (8.6±1.7) d, significantly less than (1.35±0.04)×104 yuan and (13.5±2.3) d in the drainage group (t=-12.1, -9.17; P<0.05). The rate of postoperative analgesia in the closure group was 36% (10/28), significantly lower than 60% (18/30) in the drainage group (χ2=5.78, P<0.05). All patients were followed up for 6-24 months, and no biliary stricture was observed. Conclusions Compared with T tube drainage, laparoscopic common bile duct re-exploration with primary closure is a safe and feasible surgical approach with the advantages of shorter length of hospital stay, less hospitalization expense and less postoperative pain. Key words: Laparoscopes; Surgical procedures, minimally invasive; Suture techniques; Drainage; Choledocholithiasis