PWE-154 Primary duct closure after laparoscopic bile duct exploration for choledocholithiasis is a safe and effective approach

Introduction The common bile duct is traditionally managed with T-tube drainage after choledochotomy and removal of common bile duct (CBD) stones, but this approach carries an associated tube-related morbidity rate, including bile leak, of 10.5–20%. This study examines the safety and effectiveness of laparoscopic CBD exploration (LCBDE) followed by primary duct closure. Methods This is a retrospective analysis of 94 consecutive patients (27 male) who underwent LCBDE between October 2002 and December 2011. The duct was primarily closed in all patients. The results shown represent the median (range). Results All procedures were completed laparoscopically. The maximum diameter of the CBD was 9.7 (3–30) mm, and it was dilated in 93% of patients. The number of CBD stones was 2 (0–20). The exploration was transcystic in 14 patients and trans-CBD in 80 patients. The biliary tree was clear at the end of exploration with no subsequent evidence of retained stones in 92 patients (97.8%). The operating time was 117 (22–395) min. Postoperative bile leak occurred in four patients (4.5%) who were managed successfully with re-laparoscopy and suturing of the choledochotomy (n=2), laparoscopic insertion of biliary stent (n=1) and conservatively (n=1). The overall morbidity rate was 8% and included pulmonary complications (n=3), cholangitis (n=2), myocardial infarction (n=1) and wound infection (n=1). There were no operative deaths, and the postoperative hospital stay was 1 (0–51) day. At a follow-up of 48.2 (24–82) months, 92.5% of patients (n=87) had no biliary symptoms, one patient required endoscopic extraction of a retained stone, one developed bile duct stricture that was managed successfully by endoscopic balloon dilatation, and four patients (4.5%) failed to attend the follow-up. Conclusion Primary duct closure following LCBDE is safe, and can be employed as an alternative to T-tube insertion with short hospital stay and lower morbidityrate. Competing interests None declared.