Can laparoscopic common bile duct exploration be performed without any drainage? A propensity score-matched study.

Abstract

Introduction: Although laparoscopic common bile duct exploration (LCBDE) is considered a safe and effective method for treating choledocholithiasis, the absence of any biliary or abdominal drainage during surgery remains controversial.

Aim: This paper aims to investigate the feasibility and safety of LCBDE without drainage, particularly abdominal drainage.

Materials and methods: This retrospective analysis included 499 patients who underwent LCBDE with primary closure of the common bile duct and without any kind of biliary drainage during surgery. In 322 individuals, the surgery involved routine abdominal drainage (drainage group), whereas in 177 cases, no abdominal drainage was performed (nondrainage group). Baseline characteristics of the 2 groups were compared, followed by propensity score matching (PSM) to balance confounding factors. We compared effect indicators and complication rates between both groups.

Results: After PSM, each group included 124 patients. There were no significant differences between the 2 groups in terms of overall and individual complication rates, except for a lower incidence of hyperamylasemia in the nondrainage group. The surgery time, duration of postoperative antibiotic use, and the total and postoperative length of hospital stay was significantly shorter in the nondrainage group. Similarly, the total hospitalization cost and postoperative usage of analgesics and antispasmodics were also considerably lower in the nondrainage group.

Conclusions: Nondrainage LCBDE is associated with shorter recovery time and better patient outcomes, as compared with procedures involving abdominal drainage. In suitable cases, this approach is completely safe and feasible.