BACKGROUND: The common bile duct traditionally is managed with T-tube drainage after choledochotomy and removal of common bile duct (CBD) stones, but this approach carries an associated tube-related morbidity rate, including bile leak, of 10.5-20 %. This study examined the safety and effectiveness of laparoscopic CBD exploration (LCBDE) followed by primary duct closure. METHODS: This is a retrospective analysis of 120 consecutive patients (81 female) who underwent LCBDE between October 2002 and October 2012. The duct primarily was closed in all patients. The results are given as median (range). RESULTS: Trans-CBD exploration was performed in 120 patients and all cases were successfully completed laparoscopically. The maximum diameter of the CBD was 9.4 (3-30) mm and the number of CBD stones detected was 3 (0-20). The biliary tree was clear at the end of exploration in 116 patients (96.7 %). The operating time was 122 (70-360) min. The mortality rate, morbidity rate, postoperative bile leak rate, rate of retained CBD stones after the primary procedure, and CBD stricture rate at a follow-up of 39.2 (2-82) months were 0, 8.3, 2.5, 3.3, and 0.8 %, respectively. The postoperative hospital stay was 2.1 (1-29) days. CONCLUSION: Primary duct closure following LCBDE is safe, can be employed routinely as an alternative to T-tube insertion, and has a short hospital stay and low morbidity rate.
BACKGROUND: The common bile duct traditionally is managed with T-tube drainage after choledochotomy and removal of common bile duct (CBD) stones, but this approach carries an associated tube-related morbidity rate, including bile leak, of 10.5-20 %. This study examined the safety and effectiveness of laparoscopic CBD exploration (LCBDE) followed by primary duct closure. METHODS: This is a retrospective analysis of 120 consecutive patients (81 female) who underwent LCBDE between October 2002 and October 2012. The duct primarily was closed in all patients. The results are given as median (range). RESULTS: Trans-CBD exploration was performed in 120 patients and all cases were successfully completed laparoscopically. The maximum diameter of the CBD was 9.4 (3-30) mm and the number of CBD stones detected was 3 (0-20). The biliary tree was clear at the end of exploration in 116 patients (96.7 %). The operating time was 122 (70-360) min. The mortality rate, morbidity rate, postoperative bile leak rate, rate of retained CBD stones after the primary procedure, and CBD stricture rate at a follow-up of 39.2 (2-82) months were 0, 8.3, 2.5, 3.3, and 0.8 %, respectively. The postoperative hospital stay was 2.1 (1-29) days. CONCLUSION: Primary duct closure following LCBDE is safe, can be employed routinely as an alternative to T-tube insertion, and has a short hospital stay and low morbidity rate.
Authors: A Cuschieri; E Lezoche; M Morino; E Croce; A Lacy; J Toouli; A Faggioni; V M Ribeiro; J Jakimowicz; J Visa; G B Hanna Journal: Surg Endosc Date: 1999-10 Impact factor: 4.584
Authors: Mauro Podda; Francesco Maria Polignano; Andreas Luhmann; Michael Samuel James Wilson; Christoph Kulli; Iain Stephen Tait Journal: Surg Endosc Date: 2015-06-20 Impact factor: 4.584
Authors: Marc Zerey; Stephen Haggerty; William Richardson; Byron Santos; Robert Fanelli; L Michael Brunt; Dimitrios Stefanidis Journal: Surg Endosc Date: 2017-12-22 Impact factor: 4.584