Is Biliary Drainage Really Necessary after Laparoscopic Common Bile Duct Exploration?.
- Author:
Seung Jae ROH
1
;
In Seok CHOI
;
Joo Ik MOON
;
Dae Sung YUN
;
Won Jun CHOI
;
Sang Eok LEE
;
Yu Mi RA
Author Information
1. Department of Surgery, Konyang University, College of Medicine, Daejeon, Korea. choiins@kyuh.ac.kr
- Publication Type:Original Article
- Keywords:
Common bile duct stones;
Laparoscopic common bile duct exploration;
Primary closure
- MeSH:
Bile;
Common Bile Duct;
Drainage;
Humans;
Postoperative Complications;
Recurrence
- From:Journal of Minimally Invasive Surgery
2013;16(3):27-33
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: Laparoscopic common bile duct exploration (LCBDE) has been the alternative treatment in patients who have failed endoscopic removal. Until now, biliary drainage has been performed as a customary practice after LCBDE in order to prevent complication or to prevent remnant stones from draining out; however, the drainage was often caused by other complications. For this reason, we have been performing LCBDE with primary closure. The aim of this study was to report on the efficacy and safety of primary closure. METHODS: Of 207 cases of common bile duct stones with performance of LCBDE from March 2001 to January 2013, 199 cases were included. Eight cases were excluded due to the open conversion. The 199 patients were subdivided into the primary closure group (P-group) and the drainage group (D-group). RESULTS: Of 199 patients, there were 36 (18.1%) with primary closure, and 163 (81.9%) with drainage. No significant difference in characteristics was observed between the two groups, except for smaller stones in the P-group (11.4+/-6.0 mm, 16.2+/-8.0 mm, p<0.01). Mean number of postoperative hospital days was significantly shorter in the P-group (6.0+/-3.1 days, 7.6+/-3.8 days, p=0.019). The rate of postoperative complications was higher in the D-group, but showed no statistical significance. There were six cases of bile leakage in the D-group, and two cases in the P-group, but without statistical significance (p=0.638). The recurrence rate was significantly lower in the P-group (5.6%, 22.1%, p=0.02). CONCLUSION: In the P-group, the number of mean postoperative hospital days was lower, and a lower rate of recurrence was observed. Compared with other types of drainage after LCBDE, the primary closure would be a sufficient method. Therefore, it can be regarded as safe enough and feasible.
