EFFICACY AND SAFETY OF PRIMARY CLOSURE OF COMMON BILE DUCT FOLLOWING LAPAROSCOPIC CHOLEDOCHOLITHOTOMY

Abstract

Following surgical intervention for symptomatic cholelithiasis, approximately 10 to 15 percent of patients are diagnosed with choledocholithiasis, characterized by the presence of stones in CBD. Several surgeons perform open CBD exploration with primary duct closure. However, few surgeons perform duct closure laparoscopically due to technical difficulties and concerns about missed stones and postoperative complications. Thus, we evaluated the efficacy and safety of the primary closure of the common bile duct following laparoscopic choledocholithotomy. In this prospective observational study, 62 patients with CBD stones were confirmed pre-operatively by abdominal ultrasonography and/or magnetic resonance cholangiopancreatography (MRCP). CBD radiological findings and demographics were noted. Details on the intraoperative technique, overall operating time, and post-operative complications were observed. Patients were followed for one month, and post-operative data were collected and analysed. Most of the enrolled patients were female (69.35%), aged 41-50 (37.10%), and had abdominal pain (82.25%). 64.52% had multiple stones in the CBD of the calibre of 8–10 millimetres (40.32%). 94.52±21.58 mins was the mean operative time. CBD clearance was noted in 96.77% of cases. In most cases, intraoperative bleeding was 51–100 ml. Laparoscopic primary closure was performed in 96.77% of patients. On days 3 and 7, 9.68% and 6.45% of patients had bile leakage, respectively. The removal of abdominal drains varied significantly between cases. During the follow-up, two patients with bile leaks and jaundice after surgery were found to have retained stones and underwent post-operative ERCP without additional complications. The primary closure after LCBDE is considered a safe and effective alternative to T-tube drainage with an acceptable short-term outcome.