title: Eleven years of primary closure of common bile duct after choledochotomy for choledocholithiasis.
abstract: BACKGROUND
  The choice of surgical technique to extract stones from the common bile duct (CBD) depends on local experience, anatomical characteristics and also on the size, location and number of stones. Most authors consider choledochotomy an alternative to failed transcystic exploration, although some use it exclusively. Although the CBD is traditionally closed with T-tube drainage after choledochotomy, its use is associated with 11.3-27.5 % morbidity. This study examined the efficacy of laparoscopic CBD exploration (LCBDE) with primary closure for the treatment of CBD stones using intraoperative cholangiography (IOC).
  
  
  METHODS
  Retrospective study of 160 patients who underwent LCBDE with primary closure after choledochotomy between January 2001 and December 2012.
  
  
  RESULTS
  The diagnosis of choledocholithiasis was definitively made in all cases by IOC. The overall complication rate was 15 % and the biliary complication rate was 7.5 %. Bile leakage was reported in 11 patients (6.8 %). In over half the cases (63.6 %), no further action was required and the leak closed spontaneously. Six patients were reoperated (3.75 %), two for bile peritonitis and four for haemoperitoneum. The success rate for stone clearance was 96.2 %. The mortality rate and CBD stricture rate were 0 %.
  
  
  CONCLUSIONS
  Primary closure after choledochotomy to clear stones from the CBD is a safe technique that confers excellent results and allows one-stage treatment.
authors.affiliation: Department of Surgery, Hospital Universitario Doctor Peset, Av. Gaspar Aguilar, 90, 46017, Valencia, Spain. estelles.vidagany.nuria@gmail.com.
authors.forename: Nuria
authors.initials: N
authors.lastname: Estellés Vidagany
authors.affiliation: Department of Surgery, Hospital Universitario Doctor Peset, Av. Gaspar Aguilar, 90, 46017, Valencia, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Domingo Del Pozo
authors.affiliation: Department of Surgery, Hospital Universitario Doctor Peset, Av. Gaspar Aguilar, 90, 46017, Valencia, Spain.
authors.forename: Nuria
authors.initials: N
authors.lastname: Peris Tomás
authors.affiliation: Department of Surgery, Hospital Universitario Doctor Peset, Av. Gaspar Aguilar, 90, 46017, Valencia, Spain.
authors.forename: Jose Ángel
authors.initials: JÁ
authors.lastname: Díez Ares
authors.affiliation: Department of Surgery, Hospital Universitario Doctor Peset, Av. Gaspar Aguilar, 90, 46017, Valencia, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Vázquez Tarragón
authors.affiliation: Department of Surgery, Hospital Universitario Doctor Peset, Av. Gaspar Aguilar, 90, 46017, Valencia, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Blanes Masson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001662:Biliary Tract Surgical Procedures / Q000379:methods; D002758:Cholangiography / Q000379:methods; D017081:Cholecystectomy, Laparoscopic / Q000379:methods; D042883:Choledocholithiasis / Q000150:complications / Q000601:surgery*; D003135:Common Bile Duct / Q000601:surgery*; D004322:Drainage / Q000379:methods; D005260:Female; D042882:Gallstones / Q000150:complications / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
keywords: CBD (common bile duct); Choledocholithiasis; Choledochotomy; Laparoscopy; Primary closure