title: Primary Closure Versus Biliary Drainage After Laparoscopic Choledocotomy: Results of a Comparative Study.
abstract: BACKGROUND
  To evaluate the feasibility, safety, and short-term outcomes of primary closure (PC) and biliary drainage (BD), after the laparoscopic treatment of common bile duct (CBD) stones by choledocotomy.
  
  
  METHODS
  Between January 2009 and December 2014, 102 patients underwent laparoscopy for lithiasis of the CBD. Intraoperative cholangiography was systematically performed, followed by choledocoscopy, depending on the size of the CBD.
  
  
  RESULTS
  Eighty (78.4%) of the 102 patients underwent laparoscopic stone extraction by choledocotomy, and were assigned to 2 groups: PC (group A, n=25), and BD (group B, n=55). Groups A and B were comparable in terms of age (62.3±26.1 vs. 66.0±19.3 y; P=0.53), the percentage of women (72.0% vs. 76.4%; P=0.68), body mass index (25.9±6.1 vs. 26.9±4.4 kg/m; P=0.52), and CBD diameter (11.6±3.1 vs. 12.1±3.8 mm; P=0.59). The mean durations of surgery and of hospital stay were significantly shorter in group A: 179±38 versus 211±57 minutes (P=0.02) and 5.4±2.0 versus 8.4±3.2 days (P<0.001). Groups A and B were comparable in terms of serious postoperative morbidity (Clavien-Dindo scores of 3, 4, and 5): 2 versus 4 (P=1). In group B, bile drain removal was complicated by choleperitoneum in 3 cases.
  
  
  CONCLUSIONS
  With shorter durations of surgery and hospital stay, equivalent postoperative morbi-mortality, and an absence of the specific morbidity due to bile drainage, PC may be considered a safe and feasible option for the laparoscopic management of CBD stones by choledocotomy.
authors.affiliation: Department of General and Digestive Surgery, La Cavale Blanche University Hospital, Brest, France.
authors.forename: Cyril
authors.initials: C
authors.lastname: Audouy
authors.forename: Jérémie
authors.initials: J
authors.lastname: Thereaux
authors.forename: Gaby
authors.initials: G
authors.lastname: Kansou
authors.forename: Geoffroy
authors.initials: G
authors.lastname: Leroux
authors.forename: Bogdan
authors.initials: B
authors.lastname: Badic
authors.forename: Jean P
authors.initials: JP
authors.lastname: Bail
mesh_terms: D000368:Aged; D003135:Common Bile Duct / Q000601:surgery*; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D004322:Drainage / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D058106:Wound Closure Techniques