Comparative Studying On Laparoscopic And Open Primary Closure For The Treatment Of Common Bile Duct Stones

Objectives:To discuss the clinical efficacy of primary suture following laparoscopic common bile duct exploration (LCBDE) for choledocholithiasis.Materials and Methods:The clinical data of 322 patients with common bile duct stones undergoing primary suture from January 2010 to December 2014 were retrospectively analyzed.133 patients with laparoscopic common bile duct were selected as LCBDE group; 189 patients with open operation were selected as the open group. The operative time, blood loss, pain score, postoperative ambulation time, hospitalization time, hospitalization expenses, postoperative complications rate of the two groups were observed and compared.Results:All the patients in both group successfully accomplished the procedure. No complications occurred in the process of surgery and the LCBDE group are finished successfully without conversion to open operation。The blood loss of the LCBDE group[(33.9±18.3)ml] was less than the open group[(72.6±38.5)ml] (P<0.01).The pain score was lower in the LCBDE group (3.8±1.6)than the open group (5.3±1.2) (P<0.01).The LCBDE group (9.2±2.1hours) showed earlier out-of-bed activity than the open group (14.3±2.7hours) (P<0.01). The hospitalization expenses of the LCBDE group(3.03±0.50 wan yuan) was lower than the open group (3.50±0.68 wan yuan) (P<0.01). The postoperative hospital stay of the LCBDE group(12.0±2.1 days)was shorter than the open group (15.0±4.4) (P<0.01). The operation time of the LCBDE group (155.53±26.41minutes) was shorter than the open group (158.62±30.56) minutes(P>0.05). There was no significant difference between the two groups in operation time and postoperative complications rate (P>0.05).Conclusion:LCBDE and the open choledocholithotomy with primary suture of the common bile duct are both effective and safe procedures for common bile duct stones. Compared with the open operation, LCBDE with primary suture has smaller incision, less pain, less hospitalization costs and quicker recovery, and it is more worthy to be recommended for further clinical application.