Primary closure with knotless barbed suture versus traditional T-tube drainage after laparoscopic common bile duct exploration: a single-center medium-term experience

Abstract

Objective: Primary closure of the common bile duct (CBD) after laparoscopic CBD exploration (LCBDE) is a technical challenge. The present study was performed to evaluate the safety and effectiveness of this surgical method. Methods: This retrospective study of surgical efficacy and safety involved 79 patients who underwent primary CBD closure with a knotless unidirectional barbed suture or traditional T-tube drainage after LCBDE for CBD stones. Results: The average suturing time, operation time, and postoperative hospital stay were significantly shorter in the primary closure group than T-tube group. There were no significant differences in the mean diameter of the CBD, number of stones, or incidence of postoperative complications between the two groups. No patients developed recurrence of CBD stones during the median follow-up of 21.5 months. Conclusions: After LCBDE and intraoperative choledochoscopy, primary closure with knotless unidirectional barbed sutures is a safe and effective therapeutic option for patients with cholelithiasis and concurrent CBD stones. This is especially true when the CBD is dilated more than 8 mm.

Comparative study of three common bile duct closure techniques after choledocholithotomy: safety and efficacy

“…Our study found that patients with the PDC had shorter operative and choledochotomy closure times than those with the TTD and ABS with an insignificant difference. Our results were consistent with several studies [ 9 , 13 , 25 , 35 , 41 , 45 ]. The long operative time in the ABS group was attributed to the time used for confirmation of stent position in the duodenum which was very crucial to guard against specific stent complications.…”

“…We agree with Deng et al [ 14 ] that this low incidence results from mandatory intraoperative confirmation of CBD clearance by cholangiogram and choledochoscope. Our study revealed no statistically significant difference among the 3 groups, and this was consistent with several studies [ 9 , 11 , 13 , 14 , 41 ].…”

“…Biliary stricture is one of the major concerns for patients who have undergone CBDE. In most studies [40][41][42], the rate of the biliary stricture was very low. Our result was consistent with this finding as the overall incidence of the CBD stricture was 0.9%.…”

“…A recent two meta-analyses showed that the PDC group had significantly lower postoperative complications compared with the TTD group [ 14 , 37 ]. Moreover, a recent clinical trial by Wu et al [ 35 ] and a retrospective study by Zhou et al [ 41 ] revealed that no differences were found between the TTD group and PDC group.…”

Primary closure combined with C-tube drainage through cystic duct after laparoscopic common bile duct exploration is safe and feasible for patients

“…However, clinical studies have shown that T tube drainage has disadvantages including tube blockage, tube slip and long retention time, even causes infection of the skin or soft tissues. Most importantly, the integrity of the common bile duct is ruined, which will lead to bilary leakage ( 7 , 11 , 15 ). Therefore, it's crucial to choose an appropriate bile drainage method for the patients.…”