title: Laparoscopic bile duct exploration via choledochotomy followed by primary duct closure is feasible and safe for the treatment of choledocholithiasis.
abstract: BACKGROUND
  The common bile duct traditionally is 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 examined the safety and effectiveness of laparoscopic CBD exploration (LCBDE) followed by primary duct closure.
  
  
  METHODS
  This is a retrospective analysis of 120 consecutive patients (81 female) who underwent LCBDE between October 2002 and October 2012. The duct primarily was closed in all patients. The results are given as median (range).
  
  
  RESULTS
  Trans-CBD exploration was performed in 120 patients and all cases were successfully completed laparoscopically. The maximum diameter of the CBD was 9.4 (3-30) mm and the number of CBD stones detected was 3 (0-20). The biliary tree was clear at the end of exploration in 116 patients (96.7 %). The operating time was 122 (70-360) min. The mortality rate, morbidity rate, postoperative bile leak rate, rate of retained CBD stones after the primary procedure, and CBD stricture rate at a follow-up of 39.2 (2-82) months were 0, 8.3, 2.5, 3.3, and 0.8 %, respectively. The postoperative hospital stay was 2.1 (1-29) days.
  
  
  CONCLUSIONS
  Primary duct closure following LCBDE is safe, can be employed routinely as an alternative to T-tube insertion, and has a short hospital stay and low morbidity rate.
authors.affiliation: Department of Hepato-Pancreato-Biliary Surgery, North Manchester General Hospital, Delaunays Road, Crumpsall, Manchester,, M8 5RB, UK, ynskhaled@gmail.com.
authors.forename: Yazan S
authors.initials: YS
authors.lastname: Khaled
authors.forename: Deep J
authors.initials: DJ
authors.lastname: Malde
authors.forename: Ciaran
authors.initials: C
authors.lastname: de Souza
authors.forename: Amun
authors.initials: A
authors.lastname: Kalia
authors.forename: Basil J
authors.initials: BJ
authors.lastname: Ammori
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000209:etiology; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D042883:Choledocholithiasis / Q000601:surgery*; D003135:Common Bile Duct / Q000601:surgery*; D004322:Drainage / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult