title: Primary closure and rate of bile leak following laparoscopic common bile duct exploration via choledochotomy.
abstract: BACKGROUND
  Choledocholithiasis is traditionally managed by endoscopic retrograde cholangiopancreatography or T-tube insertion following common bile duct exploration. This study examined the efficacy and safety of primary duct closure following laparoscopic common bile duct exploration (LCBDE) via choledochotomy.
  
  
  METHODS
  Between September 2011 and September 2013, 157 consecutive patients underwent LCBDE via choledochotomy.
  
  
  RESULTS
  Of 157 LCBDE procedures, 138 (87.9%) were successfully completed with primary closure of the choledochotomy. Eight patients (5.1%) underwent closure with T-tube drainage after choledochotomy and 11 patients (7.0%) were converted to open surgery. The biliary tree was free of stones at the end of surgery in 154 patients (98.1%). Postoperative bile leak occurred in 6 patients (3.8%). The median follow-up period was 18 (2-33) months, with no evidence of further bile duct stones or bile duct stricture in any patients. Univariable analysis revealed that successful duct clearance (p = 0.010) and diameter of the common bile duct (p < 0.001) were two significant risk factors for bile leak.
  
  
  CONCLUSIONS
  Primary duct closure following LCBDE is effective and safe for the management of choledocholithiasis. The postoperative bile leak rate may be low in skilled laparoscopic surgeons with a careful selection of patients.
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Hua
authors.forename: Shengping
authors.initials: S
authors.lastname: Lin
authors.forename: Daohai
authors.initials: D
authors.lastname: Qian
authors.forename: Zhigang
authors.initials: Z
authors.lastname: He
authors.forename: Ti
authors.initials: T
authors.lastname: Zhang
authors.forename: Zhenshun
authors.initials: Z
authors.lastname: Song
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000209:etiology / Q000503:physiopathology*; D001646:Bile; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects*; D042883:Choledocholithiasis / Q000601:surgery*; D003135:Common Bile Duct / Q000601:surgery*; D004322:Drainage; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult