Primary duct closure safe after bile duct exploration

As an alternative to T-tube drainage (TTD), primary duct closure (PDC) is a safe and effective procedure following laparoscopic common bile duct exploration (LCBDE), a recent study has found.

Researchers retrospectively assessed 348 choledocholithiasis patients who underwent LBCDE. Of the participants, 225 received PDC while the remaining 123 underwent TTD. After propensity score matching, 116 patients remained in each group, which was then balanced in terms of background characteristics.

There were no documented cases of perioperative death, and none of the patients needed conversion into open surgery. Intra-abdominal infections, bile leakage, retained stones, and incision infections occurred at comparable rates between the two patient groups.

Meanwhile, operation time was significantly shorter in the PDC vs TTD groups, as was intraoperative blood loss lower in the former procedure (p<0.05 for both). Postoperative hospital stay, postoperative exhaust time, abdominal drainage time, and postoperative antibiotic use time were all likewise significantly lower in PDC (p<0.05 for all).

In terms of biliary tract complications, bile leakage occurred in 2.6 percent of PDC patients and 6.0 percent in the TTD group. Only two such cases were of grade B, both of which recovered smoothly after symptomatic support treatment. The remaining bile leakages were grade A and resolved without intervention.

“Based on the available evidence, compared with TTD, PDC is safe and effective, and can be used as the first choice after transductal LCBDE in patients with choledocholithiasis,” the researchers said.