Analysis Of The Clinical Effect Of Primary Duct Closure After Laparoscopic Common Bile Duct Exploration Combined With Enhanced Recovery After Surgery

Background:Primary duct closure(PDC)is being widely accepted after laparoscopic common bile duct exploration(LCBDE),although there is still controversial in safety and the scope of application.Herein we presented our cases and summarized our experience of PDC in our hospital in the past 5 years.While we also explored the clinical benefit of ERAS combined with PDC,investigated the perioperative tube management strategy,to promote patient recovery better.Methods:From September 2014 to September 2019,patients undergo PDC after LCBDE by the same surgeon at Department of Hepatobiliary Surgery Zhongshan Hospital Xiamen University were enrolled in this retrospective study,to analyze the postoperative recovery and complication rate of this treatment.On this basis,the cases meeting the standard were divided into pre-ERAS group and ERAS group to compare the differences of postoperative recovery indexes.A randomized controlled study was further conducted in two groups to compare the effect of intraoperative abdominal drainage tube placement on postoperative recovery.Results:In the last 5 years,232 consecutive LCBDE with PDC were performed.There were no death cases,the average operation time was 124 min,the average intraoperative blood loss was 13.5 ml,and the incidences of overall postoperative complications was 9.1%,mainly includes bile leak or wound infection.Further analysis shows that the total hospital stay,postoperative hospital stay,operation time,drainage time,time of postoperative gastrointestinal function recovery and biochemical indicators recovery in the ERAS group were significantly shortened compared with the pre-ERAS group(P<0.05).And The incidence of postoperative complications is 12.8%in the pre-ERAS group with only 4.1%in ERAS group(P<0.05).The none-abdominal drainage group was better in postoperative recovery indexes compared with the controlled group,but there was no significant difference between them.Conclusion:To patients according with operation indications,LCBDE with PDC is effective and safe for the treatment of choledocholithiasis,which could be the first choice.The perioperative strategy of ERAS is more favorable for patients,further optimized pipeline management can be a supplement to ERAS.