Primary closure versus T-tube drainage after laparoscopic common bile duct exploration in patients with non-severe acute cholangitis

Primary Closure Versus T-Tube Drainage on Common Bile Duct Exploration for Choledocholithiasis: An Updated Systematic Review and Meta-Analysis

Introduction: Laparoscopic common bile duct exploration (LCBDE) is a critical procedure for managing choledocholithiasis, with primary closure (PC) and T-tube drainage (TTD) as common methods for common bile duct closure. However, the substantial number of new studies comparing PC and TTD underscores the need for an updated meta-analysis. Therefore, this study aims to compare surgery-related outcomes in PC and TTD for biliary duct closure following LCBDE. Methods: We searched PubMed, Embase, and Cochrane Library databases on June 20, 2024. Mean differences (MDs) and risk ratios with 95% confidence intervals (CIs) were pooled for continuous and binary outcomes, respectively. Heterogeneity was assessed with I2 statistics. Statistical analysis was performed using Software R, version 4.3.3. Results: A total of 31 studies comprising 4432 patients were included. A total of 2301 (51.9%) were submitted to PC and 2131 (48.1%) were submitted to TTD. The mean age of patients ranged from 39 to 69.8 years and 44.3% were male. Compared with TTD, PC significantly reduced retained stones (odds ratio [OR] 0.57; 95% CI 0.35-0.93; P = .02; I2 = 0%), biliary peritonitis (OR 0.22; 95% CI 0.08-0.60; P < .01; I2 = 0%), operative time (MD -21.07 minutes; 95% CI -27.68-14.46; P <. 01; I2 = 97%) and postoperative hospital stay (MD -2.20 days; 95% CI -2.80-1.60; P <. 01; I2 = 96%). However, there were no significant differences between the groups in recurrent stones (OR 0.57; 95% CI 0.32-1.02; P = .06; I2 = 0%), bile leakage (OR 0.89; 95% CI 0.65-1.23; P = .49; I2 = 0%), bile duct stricture (OR 2.08; 95% CI 0.36-12.11; P = .42; I2 = 0%), pneumonia (OR 1.38; 95% CI 0.66-2.88; P = .39; I2 = 0%), and pancreatitis (OR 0.64; 95% CI 0.29-1.38; P = .25; I2 = 0%). Conclusion: In this meta-analysis, PC was associated with decreased retained stones, biliary peritonitis, operative time, and postoperative hospital stay. However, no significant differences were observed for the other outcomes. These findings underscore PC as a safe and reliable method for bile duct closure following LCBDE.

Laparoscopic primary suture of the common bile duct in patients with common bile duct stones: a comparative analysis of two suturing methods in terms of safety, efficacy, and convenience with 16-month follow-up

BACKGROUND

Primary suturing of the common bile duct (CBD) is increasingly used in laparoscopic common bile duct exploration (LCBDE) for selected patients, though the optimal suturing method remains unclear. This study compares the efficacy of continuous versus interrupted sutures for primary CBD closure in patients with CBD stones.

METHODS

A retrospective analysis was conducted on 120 patients with CBD stones who underwent primary CBD closure at Yancheng First People's Hospital from October 2022 to December 2023. Data included demographics, hospital stay, complications, and follow-up outcomes. Of these, 69 received continuous sutures, and 51 received interrupted sutures.

RESULTS

No significant differences were found in age, gender, body mass index (BMI), CBD diameter, preoperative bilirubin levels, or stone residuals between groups. The incidence of postoperative fever, bile leakage, electrolyte disturbances, bleeding, wound infection, and CBD stricture was similar. Continuous suturing required less operative time than interrupted suturing (p < 0.01).

CONCLUSION

Both continuous and interrupted suturing techniques are safe and effective for CBD closure in selected patients, though continuous suturing is more time-efficient.

Analysis of risk factors for bile leakage after laparoscopic exploration and primary suture of common bile duct

BACKGROUND

Bile leakage is a common complication following laparoscopic common bile duct exploration (LCBDE) with primary duct closure (PDC). Identifying and analyzing the risk factors associated with bile leakage is crucial for improving surgical outcomes.

AIM

To explore the value analysis of common risk factors for bile leakage after LCBDE and PDC, with a focus on strict adherence to indications.

METHODS

Clinical data of 106 cases undergoing LCBDE + PDC in the Hepatobiliary and Pancreatic Surgery Department (Division 1) of Chuzhou First People's Hospital from April 2019 to March 2024 were collected. Retrospective and multiple factor regression analysis were conducted on common risk factors for bile leakage. The change in surgical time was analyzed using the cumulative summation (CUSUM) method, and the minimum number of cases required to complete the learning curve for PDC was obtained based on the proposed fitting curve by identifying the CUSUM maximum value.

RESULTS

Multifactor logistic regression analysis showed that fibrinous inflammation and direct bilirubin/indirect bilirubin were significant independent high-risk factors for postoperative bile leakage (P < 0.05). The time to drain removal and length of hospital stay in cases without bile leakage were significantly shorter than in cases with bile leakage (P < 0.05), with statistical significance. The CUSUM method indicated that a minimum of 51 cases were required for the surgeon to complete the learning curve (P = 0.023).

CONCLUSION

With a good assessment of duodenal papilla sphincter function, unobstructed bile-pancreatic duct convergence, exact stone clearance, and sufficient surgical experience to complete the learning curve, PDC remains the preferred method for bile duct closure and is worthy of clinical promotion.

Is Laparoscopic Common Bile Duct Exploration Safe in Patients with Acute Cholangitis Caused by Common Bile Duct Stones? Results of a Systematic Review

Introduction: The traditional method of performing open common bile duct exploration (OCBDE) was replaced by a less invasive procedure known as laparoscopic common bile duct exploration (LCBDE) in elective surgery. But at present, the application of this technique is considered novel and controversial to treat acute cholangitis (AC). The aim of our systematic review was to investigate the safety and efficacy of laparoscopic surgery in patients with AC. Methods: Studies containing information on patients diagnosed with AC who underwent LCBDE were included. A search for relevant articles was carried out, in the Cochrane Library, PubMed, and Google Scholar databases. All studies included in the systematic review were assessed using the Newcastle-Ottawa Quality Assessment Scale. Results: A total of 10 studies were included. Seven were retrospective and three were prospective. Only one was a randomized controlled trial. There were three studies that compared elective LCBDE and emergency LCBDE. Two studies compared between primary closure and T-tube drainage. Two other studies focused on the comparison between LCBDE and OCBDE. One study examined the comparison of LCBDE and endoscopic retrograde cholangiopancreatography. Another study addressed the issue of conversion in LCBDE. One study compared early and delayed LCBDE. Conversion rates ranged from 0% to 16.92%. Morbidity ranged from 0% to 26.3%, and mortality ranged from 0% to 3.07%. There was no difference in terms of retained, residual, or recurrent stones, bile leak, hemorrhage, and postoperative pancreatitis, and this, comparing the different groups of patients. Bile duct and intestinal injuries as well as biliary stricture were not common. The average length of hospital stays was approximately 5.86 days, ranging from 2 to 11.12 days. Conclusion: The one-stage urgent LCBDE, while subject to debate, proves to be a secure, feasible, approach for managing nonsevere AC.

The safety and efficacy of primary duct closure after laparoscopic common bile duct exploration in patients with mild-to-moderate calculus-associated acute cholangitis: a retrospective cohort study

While laparoscopic common bile duct exploration with primary duct closure (LCBDE + PDC) has been considered a feasible and safe treatment for cholecystocholedocholithiasis, uncertainties remain regarding its effectiveness and safety in patients with mild-to-moderate calculus-associated acute cholangitis. Therefore, this study aims to investigate the safety and efficacy of LCBDE + PDC specifically in patients with mild-to-moderate acute cholangitis (AC). Patients with cholecystocholedocholithiasis who underwent LCBDE + PDC treatment at our hospital between July 2020 and September 2022 were included. The patients were divided into two groups based on the presence of cholangitis: acute cholangitis (AC group) and non-acute cholangitis (non-AC group). A total of 136 patients underwent LCBDE + PDC treatment, with 65 in the AC group and 71 in the non-AC group. No deaths occurred after surgery in either group. The AC group had longer drainage tube retention time (5 (4-7) days vs. 4 (3-5) days, P < 0.001), postoperative hospital stay (8 (6-9) days vs. 6 (5-7) days, P < 0.001), and total hospital stay (12 (9.5-15) days vs. 10 (8-13) days, P < 0.001) compared to the non-AC group. However, there were no significant differences between the two groups in terms of operation time, estimated blood loss, and the rate of using holmium laser lithotripsy. The incidence of postoperative complications was similar between the two groups. Our study demonstrates that LCBDE + PDC is a safe and feasible treatment for patients with mild-to-moderate calculus-associated acute cholangitis who meet the criteria for primary duct closure.

The efficacy and safety of laparoscopic common bile duct exploration with primary duct closure for cholecystolithiasis combined with choledocholithiasis

Cholecystolithiasis combined with choledocholithiasis represents a prevalent disease. At present, regarding the management of the common bile duct (CBD), T-tube drainage (TTD) and primary duct closure (PDC) emerge as two prominent approaches for biliary tract repair after laparoscopic CBD exploration (LCBDE). Here, retrospective analysis was conducted on the clinical records of 157 patients who underwent LCBDE at our hospital between January 2019 and January 2022. All patients were categorized into the PDC group or the TTD group based on the chosen CBD treatment approach. A comparative assessment was made across demographic factors, preoperative conditions, surgical particulars, and postoperative complications. The results showed that PDC is recommended for patients with a limited number of small stones, particularly when the CBD is in the 10-15 mm diameter range.

T‑tube versus internal drainage tube in laparoscopic common bile duct exploration

The 203 patients who underwent laparoscopic common bile duct exploration for choledocholithiasis were retrospectively analyzed. The patients were divided into internal drainage tube group (n=87) and T-tube group (n=116). Total bilirubin, direct bilirubin, alanine aminotransferase (AST), aspartate aminotransferase (ALT), the diameter of common bile duct, number of stones, operation time, intraoperative bleeding, postoperative hospital stay and postoperative complications were compared between the two groups. Possible influencing factors were selected as independent variables, and the operation mode was selected as the dependent variable for multifactor unconditional logistic regression analysis. There were no significant differences in the sex, age, total bilirubin, direct bilirubin, AST, ALT, operation time, intraoperative blood loss, postoperative hospital stay and postoperative biliary leaks between the two groups (P>0.05). The diameter of the common bile duct was smaller and the incidence of multiple stones in the common bile duct was lower in the internal drainage tube group compared with that in the T-tube group (P<0.05). The results of multifactor unconditional logistic regression analysis demonstrated that the diameter of the common bile duct and the number of stones in the common bile duct were associated with the operation mode as influencing factors. In conclusion, Patients with multiple stones in the common bile duct or with a wide diameter of the common bile duct are more likely to have T-tube placed rather than an internal drainage tube.

Internet+Continuous Nursing Mode in Home Nursing of Patients with T-Tube after Hepatolithiasis Surgery

This study was to explore the effect of a continuous nursing model based on the mobile Internet in the home nursing of patients with T-tube after hepatolithiasis surgery. A continuous nursing system based on the mobile Internet was constructed, and 94 discharged patients with T-tube after biliary tract surgery were selected as the study subjects. The differences of complication rate, referral rate, nursing satisfaction, self-care ability, and quality of life score through the 36-item short form health survey (SF-36) after routine health education nursing (control group, n = 47) and continuous nursing mode based on the Internet (observation group, n = 47) were explored. The results showed that the success rate of the continuous nursing system based on mobile Internet in processing user requests was 96.2%. After nursing, the total complication rates of the control group and the observation group were 34.0% and 6.4%, the total satisfaction rates were 42.6% and 87.2%, and the referral rates were 23.4% and 6.4%, respectively, and the difference was statistically significant (P < 0.05). After nursing, the scores of self-care ability and SF-36 quality of life in the observation group were higher than those in the control group, and the difference was statistically significant (P < 0.05). In summary, the continuous nursing platform based on mobile Internet technology can meet the needs of users, and the nursing mode can significantly improve the home self-care ability of discharged patients with T-tube after surgery and improve the nursing effect, which is conducive to the rehabilitation of patients.