Primary duct closure combined with transcystic drainage versus T‐tube drainage after laparoscopic choledochotomy

Abstract

Background We compared the post‐operative course and final outcome of primary duct closure combined with transcystic drainage with those of T‐tube drainage. Methods We retrospectively analysed 112 consecutive patients treated with laparoscopic choledochotomy for common bile duct stones between February 2014 and December 2017. Primary closure with transcystic drainage was performed in 59 patients (group A), and laparoscopic choledochotomy with T‐tube drainage was performed in 53 (group B). The primary endpoints were morbidity, the bile drainage quantity, operative time, post‐operative stay, time until return to work and post‐operative complications. Results The operation was successfully completed in all patients. The return to work period in group A was significantly shorter than that in group B (7.25 ± 1.27 versus 46.47 ± 3.86 days, P < 0.05). The average daily drainage was not significantly different between the two groups (P > 0.05). There was no significant difference in the operation time (133.75 ± 14.51 versus 132.21 ± 12.71 min) and duration of hospital stay (5.15 ± 1.23 versus 5.94 ± 0.95 days) between the two groups (P > 0.05). Bile leakage was seen in one T‐tube removal patient. No complications were reported in group A. The patients were followed for 2 to 29 months (average: 10). Normal liver function and no stricture of the bile duct were detected with ultrasonography. Conclusion Primary closure of choledochotomy and subsequent transcystic drainage is a simple and less invasive procedure than T‐tube placement.

Laparoscopic common bile duct exploration to treat choledocholithiasis in situs inversus patients: A technical review

“…Although many studies have reported that transcystic approaches have shorter postoperative hospital stays and fewer bile leaks than choledochotomies[ 69 - 72 ], in most of the cases in our review, the latter was used. Senthilnathan et al [ 17 ] mentioned that a residual gallbladder containing small calculi was found six months after LC in an SI patient[ 17 ].…”