Primary closure after laparoscopic common bile duct exploration effective in choledocholithiasis

A new study by Lunjian Xiang and team found that for certain individuals with choledocholithiasis, primary closure following laparoscopic common bile duct (CBD) exploration is safe and practicable. The findings of this study were published in the World Journal of Surgery.

The quality of life of patients may be negatively impacted by T-tube displacement and water-electrolyte problems during laparoscopic common bile duct exploration. In instance, biliary peritonitis, which necessitates reoperation, may manifest in a limited proportion of patients following T-tube removal. In order to treat choledocholithiasis, this prospective cohort research was carried out to examine the feasibility and safety of primary closure following laparoscopic CBD exploration.

The primary closure (PC) group (n = 145) consisted of patients who had laparoscopic CBD exploration with primary closure for the treatment of choledocholithiasis between January 2019 and March 2022. The T-tube drainage (TD) group (n = 153) consisted of patients who had laparoscopic CBD exploration and T-tube drainage for the treatment of choledocholithiasis at this time. Results from the perioperative period and the follow-up were gathered and statistically assessed.

The key findings of this study were:

1. The length of the procedure and postoperative hospital stay were significantly different between the TD and PC groups.

2. In terms of blood loss, the percentage of conversion to laparotomy, and postoperative measures, no discernible difference was seen.

3. The likelihood of bile leakage following surgery was influenced by preoperative albumin and total bilirubin levels.

4. The frequencies of residual and recurring stones in the TD and PC groups were 1.97% vs. 1.40% and 1.31% vs. 1.40%, correspondingly, with no significant difference (P = 1.000 for both). No patients experienced CBD stricture or carcinogenesis.

In conclusion, following laparoscopic CBD investigation, the primary closure conforms to the bodily functions of bile metabolism. It reduces the length of the procedure and the postoperative hospital stay while avoiding the drawbacks of an indwelling T-tube. Additionally, compared to those brought on by an indwelling T-tube, there are no appreciable variations in the frequencies of residual and recurrent CBD stones. In light of this, primary closure during laparoscopic CBD exploration appears safe and practical for a subset of choledocholithiasis patients.

Reference:

Xiang, L., Li, J., Liu, D., Yan, L., Zeng, H., & Liu, Y. (2022). Safety and Feasibility of Primary Closure Following Laparoscopic Common Bile Duct Exploration for Treatment of Choledocholithiasis. In World Journal of Surgery. Springer Science and Business Media LLC. https://doi.org/10.1007/s00268-022-06871-9