Is T-tube drainage no longer needed for laparoscopic common bile duct exploration? A retrospective analysis and literature review

INTRODUCTION: Primary closure (PC) following laparoscopic common bile duct exploration (LCBDE) is increasingly becoming a safe and effective option for choledocholithiasis. However, whether T-tube drainage (TTD) is no longer needed for LCBDE remains under debate. AIM: To evaluate the safety and efficacy of PC and TTD following LCBDE, and discuss their indications for selection of the procedure, combined with a literature review. MATERIAL AND METHODS: 826 consecutive patients who underwent LCBDE with PC or TTD at Shanghai Tenth People’s Hospital were reviewed. The clinical data of postoperative outcomes were compared and analyzed. Propensity score matching (PSM) was used to adjust for potential baseline confounding. RESULTS: Of these patients, 796 underwent PC and 30 underwent TTD. Twenty-eight (3.52%) cases occurred in bile leakage in PC, and all of them were treated successfully with conservative therapy. Additionally, there was no evidence of bile duct stricture and death in all PC cases. TTD was mainly performed in patients with a higher rate of cholangitis (50.00%), large stones (26.67%), impacted stones (23.33%) and laser lithotripsy (26.67%). After PSM, 23 cases with PC and TTD were included. In the PC group, the operative time, postoperative stay, hospital expenses and recurrence rate were significantly shorter or less than in the TTD group. However, there were no significant differences between the two groups in postoperative drainage time, complications, reoperations and bile duct stricture rate. CONCLUSIONS: PC following LCBDE is safe and effective for choledocholithiasis. TTD is a safe alternative method for bile duct closure in certain special cases, such as acute cholangitis, large stones, impacted stones, and laser lithotripsy.