title: Primary closure after laparoscopic common bile duct exploration versus T-tube.
abstract: BACKGROUND
  Laparoscopic common bile duct exploration (LCBDE) is now one of the main methods for treating choledocholithiasis accompanied with cholelithiasis. The objective of our study was to assess the safety and effectiveness of laparoscopic primary closure for the treatment of common bile duct (CBD) stones compared with T-tube drainage.
  
  
  METHODS
  Patients who underwent CBD stones were studied prospectively from 2002-2012 in a single center. A total of 194 patients were randomly assigned to group A (LCBDE with primary closure) with 101 cases and group B (LCBDE with T-tube drainage) with 93 cases. Intraoperative cholangiography and choledochoscopy were performed in all patients. Patient demographics, intraoperative findings, postoperative stay, complications, and hospital expenses were recorded and analyzed.
  
  
  RESULTS
  There was no mortality in the two groups. Four patients (3.96%) of group A were converted to open surgery, and three patients (3.23%) in group B. The mean operating time was much shorter in group A than in group B (102.6 ± 15.2 min versus 128.6 ± 20.4 min, P < 0.05). The length of postoperative hospital stay was longer in group B (4.9 ± 3.2 d) than in group A (3.2 ± 2.1 d). The hospital expenses were significantly lower in group A. Three patients experienced postoperative complications, which were related to the usage of the T-tube in group B. The incidences of overall postoperative complications were insignificantly lower in group A.
  
  
  CONCLUSIONS
  Laparoscopic primary closure of CBD is safe and effective for the management of CBD stones, and can be performed routinely as an alternative to T-tube drainage.
authors.affiliation: Department of General Surgery, The 101st Hospital of Chinese People's Liberation Army, Wuxi, Jiangsu, China.
authors.forename: Zhi-Tao
authors.initials: ZT
authors.lastname: Dong
authors.affiliation: Department of General Surgery, The 101st Hospital of Chinese People's Liberation Army, Wuxi, Jiangsu, China. Electronic address: wuguoz2011@126.com.
authors.forename: Guo-Zhong
authors.initials: GZ
authors.lastname: Wu
authors.affiliation: Department of General Surgery, The 101st Hospital of Chinese People's Liberation Army, Wuxi, Jiangsu, China.
authors.forename: Kun-Lun
authors.initials: KL
authors.lastname: Luo
authors.affiliation: Department of General Surgery, The 101st Hospital of Chinese People's Liberation Army, Wuxi, Jiangsu, China.
authors.forename: Jie-Ming
authors.initials: JM
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D004322:Drainage / Q000295:instrumentation; D005260:Female; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055815:Young Adult
keywords: Choledochotomy; Common bile duct exploration; Laparoscopic; Primary closure