title: Trend towards primary closure following laparoscopic exploration of the common bile duct.
abstract: BACKGROUND
  The aim of this study was the assessment of patient outcome, peri-operative complications, length of stay and duration of operation after laparoscopic primary closure of the common bile duct (CBD) compared with choledochotomy with T-tube drainage and trans-cystic exploration.
  
  
  METHODS
  Analysis of prospectively collected data on 71 explorations of the common bile duct between July 2001 and March 2006.
  
  
  RESULTS
  A total of 71 patients had exploration of the CBD. Within this group, 12 were referred after failed endoscopic retro-grade cholangiopancreatography (ERCP). The methods of exploration included trans-cystic (9 cases), choledochotomy with T-tube (12), and choledochotomy with primary closure (50). CBD stones were found in 66 patients. In the remaining cases, we found a stricture in 1, debris in 2, and dilatation of the CBD without a stone in 2. There were 5 conversions to open technique and 3 patients required postoperative ERCP (1 with permanent stenting). Peri-operative complications included T-tube (3), primary closure group (9), and trans-cystic (0). There was no statistical significant difference (Chi-square test, P = 0.296) between the groups. There was a trend towards a shorter length of stay in the primary closure group as compared with the trans-cystic and T-tube groups of 4.16, 4.44, and 6.33 days, respectively. However, it did not reach statistical significance (one-way analysis of variance with Boneferroni correction, mean difference between groups 1.89, 0.28, 2,17, statistical significance at P < 0.05). The shortest operating time was in the primary closure group (95.92 min) which was statistically significant (P < 0.001). We did not use a biliary drain in the last 48 patients.
  
  
  CONCLUSIONS
  Primary laparoscopic closure of the CBD is safe and results in a reduction in operating time. Choledochoscopy ensures clearance of the CBD and eliminates the need for T-tube.
authors.affiliation: Department of General Surgery, Wrexham Maelor Hospital, Wrexham, UK.
authors.forename: M
authors.initials: M
authors.lastname: Jameel
authors.forename: B
authors.initials: B
authors.lastname: Darmas
authors.forename: A L
authors.initials: AL
authors.lastname: Baker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003135:Common Bile Duct / Q000601:surgery*; D003137:Common Bile Duct Diseases / Q000401:mortality / Q000601:surgery*; D004322:Drainage; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000639:trends; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D016896:Treatment Outcome