Clinical Effects Comparison Of Primary Suture And T-tube Drainage Following LCBDE In The Treatment Of Common Bile Duct Stones

Objective: The traditional method following laparoscopic common bile duct exploration(LCBDE)is to place a T-tube for extrabiliary drainage.However,for patients with a wide common bile duct,stone removal clearly and lighter inflammation,the significance of indwelling T-tube is not significant.Indeed,it may lead to the occurrence of related complications.For such cases,the primary suture of the common bile duct is theoretically a more ideal treatment.This article aims to explore the clinical effects and feasibility of primary suture for the treatment of concomitant gallbladder stones and common bile duct stones following LCBDE.Methods: Retrospective analysis of the patients' clinical data who undergoing laparoscopic cholecystectomy(LC)and LCBDE from the Fourth Hospital of China Medical University between January 2015 and October 2018.According to the inclusion criteria and exclusion criteria,155 patients were enrolled in the study.They were divided into primary suture group(PS,n=39)and T-tube dranage group(TD,n=116)according to the treatment methods following LCBDE.The operation time,intraoperative blood loss,postoperative exhaust time,abdominal drainage time,postoperative hospitalization time,treatment cost and complications were analyzed by statistical methods to compare the efficacy of the two groups.Result: All patients were successfully operated.The operation time,postoperative abdominal drainage time,postoperative hospital stay,and hospitalization expenses in the PS group were(113.55±27.66)min,(5.28±1.60)days,(6.81±2.17)days,(34168.88±6352.11)yuan,corresponding TD group were(154.54±52.26)min,(7.90±3.35)days,(12.76 ± 3.35)days,(37636.95 ± 8756.29)yuan.In the PS group,each of the above indicators was averagely less than the TD group,and the difference was statistically significant(P<0.05).The intraoperative blood loss was(22.95 ± 15.63)ml in the PS group and(26.51 ± 15.50)ml in the TD group,there was no significant difference between two groups(P>0.05).The postoperative exhaust time was(2.45±0.72)days in the PS group and(2.54±1.02)days in the TD group,the exhaust time of the two groups was compared,the difference was not statistically significant(P>0.05).The recentpostoperative complications included 3 cases of pancreatitis(1 case in PS group,2 cases in TD group),6 cases of biliary leakage(3 cases in PS group,3 cases in TD group),2cases of cholangitis(1 case in PS group,1 case in TD group),5 cases of pneumonia(1case in PS group,4 cases in TD group),and 2 cases of intestinal obstruction and 1 case of incision infection in TD group.The above recent complications were all improved by conservative treatment.There were 11 cases of T-tube related complications in the TD group(5 cases of dermatitis,2 cases of electrolyte disorder,3 cases of T-tube shedding,and 1 case of sinus malformation).Overall,3 patients(7.69%)in the PS group had recent complications(1 patient with bile leakage developed pancreatitis and cholangitis,1patient with bile leakage developed pneumonia),and 11 patients(9.48%)in TD group had recent complications(1 patient developed pneumonia and incision infection,and 1patient developed pancreatitis and intestinal obstruction).There was no significant difference in the overall recent complications(P>0.05).1 patient in the TD group was complicated with recent complications(biliary leakage)and T-tube related complications(dermatitis),a total of 21 patients(18.10%)had complications after surgery.Compared the overall complications of the PS group and the TD group,the difference was not statistically significant(P>0.05).All patients were followed up after discharge(average26 months),no biliary stricture and recurrence of stones occurred.Conclusion: For patients who meet the indications,primary suture of common bile duct following LCBDE is effective and feasible.It is an ideal treatment plan compared with T-tube drainage,and it is in line with the concept of minimally invasive treatment and rapid rehabilitation surgery.When reasonablly grasping the surgical indications,it can be clinically promoted.