Application of laparoscopic common bile duct exploration and primary closure in patients with normal-diameter common bile duct stones

doi:10.3877/cma.j.issn.2095-3232.2023.01.013

Abstract

Abstract:

Objective

To evaluate the feasibility of laparoscopic common bile duct exploration and primary closure in patients with normal-diameter common bile duct stones.

Methods

Clinical data of 66 patients with common bile duct stones who underwent laparoscopic exploration and primary closure in the First Hospital of Anhui Medical University from January 2020 to December 2021 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 31 patients were male and 35 female, aged from 13 to 81 years, with a median age of 57 years.All patients were divided into the normal (n=27) and dilation groups (n=39) according to the diameter of common bile duct. The average diameter of common bile duct was (7.4±0.5) mm in the normal group and (12.8±2.4) mm in the dilation group. Laparoscopic cholecystectomy + laparoscopic common bile duct exploration + choledochoscopic lithotomy + primary closure of common bile duct were employed in all cases. Perioperative conditions and postoperative complications were observed between two groups. The operation time between two groups was compared by rank-sum test. The incidence of bile leakage was compared by Fisher's exact test.

Results

In the normal group, the median operation time, length of postoperative hospital stay and hospitalization expenses were 115(45) min, 4(2) d and 2.1(0.6)×10⁴ Yuan, and 120(62) min, 4(3) d and 2.0(0.8)×10⁴ Yuan in the dilation group, and no significant difference was observed between two groups (Z=-0.235, -0.375, 0.633; P>0.05). In the normal group, biliary leakage occurred in 2 cases during perioperative period, which was cured by conservative treatment, such as drainage and nutritional support, etc. No bile leakage occurred in the dilation group. No significant difference was noted in the incidence of bile leakage between two groups (P=0.164). No residual stone was founded in two groups by Color Doppler ultrasound at postoperative 3 months. During postoperative follow-up, no cholangitis, biliary stricture and recurrence of bile duct stones were reported in two groups.

Conclusions

Laparoscopic common bile duct exploration and primary closure is safe and effective treatment for patients with normal-diameter common bile duct stones, which does not prolong the length of hospital stay, increase hospitalization expenses or elevate the incidence of postoperative complications.

Key words: Choledocholithiasis, Laparoscopes, Laparoscopic common bile duct exploration, Primary closure

Qizhu Feng, Siyu Wang, Wenkang Yuan, Chao Zhang. Application of laparoscopic common bile duct exploration and primary closure in patients with normal-diameter common bile duct stones[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2023, 12(01): 68-72.

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References 20

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组别	例数	年龄（岁，±s）	性别（例）		合并症（例）
组别	例数	年龄（岁，±s）	男性	女性	合并症（例）
正常组	27	55±18	9	18	8
扩张组	39	59±16	22	17	6
统计值		t=-0.748	χ²=3.439		χ²=1.937
P值		0.457	0.064		0.164

组别	例数	年龄（岁，±s）	性别（例）		合并症（例）
组别	例数	年龄（岁，±s）	男性	女性	合并症（例）
正常组	27	55±18	9	18	8
扩张组	39	59±16	22	17	6
统计值		t=-0.748	χ²=3.439		χ²=1.937
P值		0.457	0.064		0.164

组别	例数	手术时间（min）	总住院时间（d）	术后住院时间（d）	住院费用（万元）
正常组	27	115（45）	7（4）	4（2）	2.1（0.6）
扩张组	39	120（62）	7（6）	4（3）	2.0（0.8）
Z值		-0.235	-1.240	-0.375	0.633
P值		0.814	0.215	0.707	0.527

组别	例数	手术时间（min）	总住院时间（d）	术后住院时间（d）	住院费用（万元）
正常组	27	115（45）	7（4）	4（2）	2.1（0.6）
扩张组	39	120（62）	7（6）	4（3）	2.0（0.8）
Z值		-0.235	-1.240	-0.375	0.633
P值		0.814	0.215	0.707	0.527

组别	例数	TB（μmol/L）		ALT（U/L）		AST（U/L）		ALP（U/L）		GGT（U/L）
组别	例数	术前	术后24 h	术前	术后24 h	术前	术后24 h	术前	术后24 h	术前	术后24 h
正常组	27	24（9）	22（13）	079（66）	056（33）	70（27）	50（24）	122（70）	109（58）	131（205）	115（159）
扩张组	39	35（16）	31（18）	135（228）	108（114）	76（81）	63（46）	220（131）	147（104）^*	376（409）	245（338）^*
Z值		-1.761	-1.625	-1.166	-1.856	-1.517	-0.637	-2.682	-2.968	-2.803	-2.611
P值		0.078	0.104	0.244	0.063	0.129	0.524	0.007	0.003	0.005	0.009

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