Laparoscopic exploration of common bile duct with primary closure versus T-tube drainage: a randomized clinical trial.
BACKGROUND
Traditionally, the common bile duct (CBD) is closed with T-tube drainage after choledochotomy and removal of CBD stones. However, the insertion of a T-tube is not without complication and the patients have to carry it for several weeks before removal. In the laparoscopic era, surgery is performed with minimally invasive techniques in order to reduce the trauma, hasten recovery, and reduce the hospital stay of patients. T-tube insertion seems to negate these benefits. This randomized study was designed to compare the two methods applied after LCBDE and to determine whether primary closure can be as safe as closure with T-tube drainage.


METHODS
From May 2000 to January 2008, 93 consecutive patients with common bile duct stones (CBDS) and gallbladder in situ were enrolled in this randomized study to undergo laparoscopic cholecystectomy with laparoscopic common bile duct exploration (LCBDE). Intraoperative findings, postoperative complications, postoperative stay, and hospital expenses were recorded and analyzed.


RESULTS
There was no mortality in both groups. A T-tube was inserted in 46 patients and the CBD was closed primarily in 47. There were no differences in the demographic characteristics or clinical presentations between the two groups. Compared with the T-tube group, the operative time and postoperative stay were significantly shorter, the hospital expenses were significantly lower, and the incidences of overall postoperative complications and biliary complications were statistically and insignificantly lower in the primary closure group.


CONCLUSIONS
LCBDE with primary closure without external drainage after laparoscopic choledochotomy is feasible and as safe as T-tube insertion.
Zhang
Wei-Jie
WJ
Department of General Surgery, The 101st Hospital of Chinese People's Liberation Army, Waxes, Jiangsu, China. mycool166@sina.com
Xu
Gui-Fang
GF
Wu
Guo-Zhong
GZ
Li
Jie-Ming
JM
Dong
Zhi-Tao
ZT
Mo
Xiao-Dong
XD
D000328:Adult; D000368:Aged; D001646:Bile; D003135:Common Bile Duct / Q000601:surgery*; D004322:Drainage / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012307:Risk Factors