A comparison of the therapeutic outcomes between primary duct closure and T-tube drainage after laparoscopic common bile duct exploration: a single-centre retrospective study

INTRODUCTION: In emergency surgery for acute obstruction of the common bile duct (CBD), primary duct closure (PC) of the CBD after laparoscopic common bile duct exploration (LCBDE) remains challenging. AIM: To explore the safety and effectiveness of this surgical method after LCBDE in patients with acute choledocholithiasis and discuss the feasibility of PC in the CBD. MATERIAL AND METHODS: This retrospective study on surgical efficacy and safety involved 232 patients treated at The Third Affiliated Hospital of Soochow University between January 2015 and December 2019. These patients underwent LC + LCBDE for acute choledocholithiasis and were categorized into PC and T-tube drainage (TD) groups based on the method of closure of the CBD. The basic preoperative information, intraoperative situation, postoperative situation, and complications were analysed and compared between groups. RESULTS: The baseline characteristics and preoperative information of patients between the 2 groups were balanced. Patients in the PC group had a shorter operation time (p < 0.001) and CBD suturing time (p < 0.001) than those in the TD group. In addition, compared with the TD group in postoperative situations, gastrointestinal recovery (p = 0.002), drainage removal (p < 0.001), and the length of postoperative hospital stay (p = 0.004) were markedly decreased in the PC group. In terms of intraoperative blood loss (p = 0.961), use of pipe washing (49.0 vs. 54.6%, p = 0.397), use of stone basket (50.0 vs. 42.3%, p = 0.243), use of electrohydraulic lithotripsy (1.0 vs. 3.1%, p = 0.525), postoperative liver function, and complications there was no significant difference between the PC and TD groups. No intraoperative transfusion and postoperative mortality occurred in either group. During 6 months of follow-up, only 1 patient showed biliary stricture in the PC group, and 2 and 4 patients in the PC and TD groups, respectively, showed residual stones. CONCLUSIONS: PC after LCBDE in acute choledocholithiasis patients displays better therapeutic outcomes than TD in some intraoperative and postoperative situations. PC of the CBD after LCBDE is a safe and effective therapeutic option in acute choledocholithiasis patients.