title: Appropriate Patient Selection Is Essential for the Success of Primary Closure After Laparoscopic Common Bile Duct Exploration.
abstract: Laparoscopic common bile duct exploration (LCBDE) is being increasingly used for management of common bile duct (CBD) stones. Primary CBD closure has been reported to have better short-term outcomes compared to T-tube placement. However, primary CBD closure cannot be performed in all patients.
  
  
  
  This study aims to evaluate the short- and long-term outcomes of LCBDE with primary CBD closure in appropriately selected patients and compare them with T-tube drainage.
  
  
  
  Retrospective analysis of patients undergoing LCBDE in our department from June 2011 to October 2014 was performed. Primary closure was performed in 52 patients (group A), and a T-tube was placed in 33 patients (group B). Patient demographics, intraoperative findings, postoperative stay, complications, and long-term follow-up data were recorded and compared.
  
  
  
  The mean operating time was much longer in group A compared to group B (113.92 vs. 95.92 min, p = 0.032). The overall complication rate (9.6 vs. 6.3%, p = 0.701) and hospital stay (4 vs. 5.11 days, p = 0.088) were similar in both groups. No patient required conversion to the open procedure. Bile leakage was more frequent in group A (5.78 vs. 0%, p = 0.279), but this was not statistically significant. All three patients with bile leakage were treated successfully by conservative measures and gradual drain withdrawal. On long-term follow-up, recurrent stones were detected in two patients in group A. No patient was found to develop CBD stricture.
  
  
  
  LCBDE and primary CBD closure has excellent short- and long-term outcomes when performed in appropriately selected patients.
authors.affiliation: Department of Hepatobiliary Surgery, Affiliated Foshan Hospital of Southern Medical University, Wei Guo Road North, Foshan, 528000, China.
authors.forename: Shun-Qian
authors.initials: SQ
authors.lastname: Wen
authors.affiliation: Department of Hepatobiliary Surgery, Heilongjiang Province Second Cancer Hospital, Harbin, China.
authors.forename: Qiu-Hui
authors.initials: QH
authors.lastname: Hu
authors.affiliation: Department of General Surgery, The Second Hospital Affiliated to Harbin Medical University, Harbin, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Wan
authors.affiliation: Department of General Surgery, The Second Hospital Affiliated to Harbin Medical University, Harbin, China.
authors.forename: Sheng
authors.initials: S
authors.lastname: Tai
authors.affiliation: Department of Hepatobiliary Surgery, Affiliated Foshan Hospital of Southern Medical University, Wei Guo Road North, Foshan, 528000, China.
authors.forename: Xue-Yi
authors.initials: XY
authors.lastname: Xie
authors.affiliation: Department of Hepatobiliary Surgery, Affiliated Foshan Hospital of Southern Medical University, Wei Guo Road North, Foshan, 528000, China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Wu
authors.affiliation: Department of Hepatobiliary Surgery, Affiliated Foshan Hospital of Southern Medical University, Wei Guo Road North, Foshan, 528000, China.
authors.forename: Shang-Lin
authors.initials: SL
authors.lastname: Yang
authors.affiliation: Department of Hepatobiliary Surgery, Affiliated Foshan Hospital of Southern Medical University, Wei Guo Road North, Foshan, 528000, China. guanqunliiao@sina.com.
authors.forename: Guan-Qun
authors.initials: GQ
authors.lastname: Liao
mesh_terms: D000328:Adult; D000368:Aged; D003135:Common Bile Duct / Q000601:surgery*; D005260:Female; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D058106:Wound Closure Techniques
keywords: Common bile duct; Common bile duct exploration; Common bile duct stone; Laparoscopic surgery; Primary closure; T tube