Clinical efficacy of T-tube-free approach in treatment of gallbladder stones and concomitant common bile duct stones
Objective: To investigate the clinical efficacy of T-tube-free approach in treatment of patients with gallbladder stones and concomitant common bile duct (CBD) stones. Methods: The clinical data of 100 patients with gallbladder stones and CBD stones treated during September 2013 to September 2014 were retrospectively studied. Of the patients, 45 cases underwent laparoscopic cholecystectomy (LC), common bile duct exploration and primary suture (primary closure group), and 55 cases were subjected to LC and endoscopic sphincterotomy (sphincterotomy group). All patients were followed-up for 12–24 months. The relevant clinical variables between the two groups were compared and analyzed. Results: There was no statistical difference in gender, age, bilirubin and transaminase levels and mean diameter of the CBD stones between the two groups (all P>0.05), but the mean diameter of the dilated CBD in primary closure group was significantly larger than that in sphincterotomy group (P<0.05). All the 100 patients successfully underwent operation and were discharged after recovery. In all patients, ambulation was resumed on postoperative day one, and no statistical difference was noted in operative time, total length of hospital stay and remnant stones (all P>0.05), but the intraoperative blood loss, time to postoperative food and water consumption, length of postoperative stay and hospitalization costs were all reduced in primary closure group compared with sphincterotomy group (all P<0.05). As for complications, postoperative bile leakage occurred in 5 cases in primary closure group, and postoperative acute pancreatitis occurred in 6 cases in sphincterotomy group, and both differences had statistical significance (both P<0.05). Conclusion: Laparoscopic common bile duct exploration and primary suture without T-tube drainage can preserve the function of sphincter of Oddi and avoid long-term T-tube placement, which shows the benefits of the minimally invasive techniques, and it is an effective and feasible approach worthy of clinical use.