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  • Title: Primary closure and rate of bile leak following laparoscopic common bile duct exploration via choledochotomy.
    Author: Hua J, Lin S, Qian D, He Z, Zhang T, Song Z.
    Journal: Dig Surg; 2015; 32(1):1-8. PubMed ID: 25613528.
    Abstract:
    BACKGROUND: Choledocholithiasis is traditionally managed by endoscopic retrograde cholangiopancreatography or T-tube insertion following common bile duct exploration. This study examined the efficacy and safety of primary duct closure following laparoscopic common bile duct exploration (LCBDE) via choledochotomy. METHODS: Between September 2011 and September 2013, 157 consecutive patients underwent LCBDE via choledochotomy. RESULTS: Of 157 LCBDE procedures, 138 (87.9%) were successfully completed with primary closure of the choledochotomy. Eight patients (5.1%) underwent closure with T-tube drainage after choledochotomy and 11 patients (7.0%) were converted to open surgery. The biliary tree was free of stones at the end of surgery in 154 patients (98.1%). Postoperative bile leak occurred in 6 patients (3.8%). The median follow-up period was 18 (2-33) months, with no evidence of further bile duct stones or bile duct stricture in any patients. Univariable analysis revealed that successful duct clearance (p = 0.010) and diameter of the common bile duct (p < 0.001) were two significant risk factors for bile leak. CONCLUSIONS: Primary duct closure following LCBDE is effective and safe for the management of choledocholithiasis. The postoperative bile leak rate may be low in skilled laparoscopic surgeons with a careful selection of patients.
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