Primary closure of bile duct versus closure over tube "T" during laparoscopic bile duct exploration

Abstract

Objetive: To compare the safety of common bile duct primary closure vs “t” tube drainage in laparoscopic common bile duct exploration (LCBDE).

Method: This is a prospective, controlled, no randomized study, of patients undergoing laparoscopic common bile duct exploration through choledochotomy, in a nine years period. In 15 patients we placed tube “T” drainage. In 20 cases a primary closure of the common bile duct was performed.

Results: No difference in age, sex or surgery indication was observed. The operative time of patients with “t” tube insertion was longer than patients with primary closure (?: 145 minutes vs. ?: 110 minutes), however this difference has not statistical significan- ce. 80% of patients with “t” tube had bile leakage of three days or less versus 30% of patients with primary closure (p<0.05). One patient with “T” tube had an acute abdomen due to biliary peritonitis after tube removal, requiring laparoscopic reintervention for lavage and drainage. There were no complications in the primary closure group. No cases of residual stones have been reported. Postoperative hospitalization time shows no difference between groups.

Conclusion: Primary closure of the common bile duct without “T” tube insertion, after LCBDE for treatment of choledo- cholithiasis, is an effective and safe procedure.