Study on Indications and Clinical Experience of Primary Suture after Common Bile Duct Exploration_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

NI Pingzhi , LIU Juan , TANG Keli , CHENG Jianhua , LUO Dan.

Department of Hepatobiliary and Pancreatic Surgery, Guizhou Province People’s Hospital, Guiyang 550002, Guizhou Province, China;

Corresponding author：

Keywords：

Common bile duct exploration; Cholecystolithiasis; Primary suture; Bile leakage; Indication

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ObjectiveTo summarize the clinical experience on primary suture after common bile duct exploration and to investigate its clinical indications and curative effects. MethodsThe clinical data of 137 patients underwent primary closure of common bile duct between February 2006 and June 2010 were analyzed retrospectively. ResultsAll operations were successful. The operative time ranged from 65-213 min (mean 129 min) and the blood loss ranged from 50-350 ml with an average of 148 ml. One hundred and twenty-four patients (90.5%) were discharged from hospital without complications within 7 d after operation. Postoperative bile leakage occurred in 13 patients (9.5%) consisted of 10 early stage cases (18.5%, 10/54) and 3 later stage cases (3.6%, 3/83), which were discharged with improvement by conservative treatment within 3 weeks after operation. Totally 113 patients (82.5%) were followed up for 2-54 months with a median time of 14 months, no residual or retained stone and biliary duct stricture occurred. ConclusionOnly with the strict indication and proficient surgical technology, primary suture after common bile duct exploration is a safe and effective way to choledocholithiasis.

Citation： NI Pingzhi,LIU Juan,TANG Keli,CHENG Jianhua,LUO Dan.. Study on Indications and Clinical Experience of Primary Suture after Common Bile Duct Exploration. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(3): 320-323. doi: Copy

1.	Zhang WJ, Xu GF, Wu GZ, et al. Laparoscopic exploration of common bile duct with primary closure versus Ttube drainage: a randomized clinical trial [J]. J Surg Res, 2009, 157(1): e1e5.
2.	Ahmed I, Pradhan C, Beckingham IJ, et al. Is a Ttube necessary after common bile duct exploration? [J]. World J Surg, 2008, 32(7): 14851488.
3.	Ambreen M, Shaikh AR, Jamal A, et al. Primary closure versus Ttube drainage after open choledochotomy [J]. Asian J Surg, 2009, 32(1): 2125.
4.	孙利国, 刘小敏. 胆总管切开取石Ⅰ期缝合64例报道 [J]. 中国普外基础与临床杂志, 2007, 14(1): 109.
5.	田明国, 杨峻峰, 胡伟, 等. 胆总管探查切口一期缝合内支架引流术 [J]. 中国普通外科杂志, 2007, 16(2): 114116.
6.	周蒙滔, 孙洪伟, 金约朋, 等. 胆总管一期缝合术在胆道外科的应用 [J]. 肝胆胰外科杂志, 2009, 21(1): 3133.
7.	Tan KK, Shelat VG, Liau KH, et al. Laparoscopic common bile duct exploration: our first 50 cases [J]. Ann Acad Med Singapore, 2010, 39(2): 136142.
8.	Pawa N, Tutton MG. Primary common bile duct closure is safe following emergency and elective exploration [J]. World J Surg, 2009, 33(8): 1779.
9.	Zhu QD, Tao CL, Zhou MT, et al. Primary closure versus Ttube drainage after common bile duct exploration for choledocholithiasis [J]. Langenbecks Arch Surg, 2010, 14(5):844848.
10.	王毅本, 曾小兵, 吴驰, 等. 胆总管探查后一期缝合胆汁漏的临床分析 [J]. 中国普外基础与临床杂志, 2005, 12(4): 351352, 360.
11.	许龙堂, 郑樟栋, 陈凯, 等. 胆总管探查后一期缝合的临床问题探讨 [J]. 中华肝胆外科杂志, 1998, 4(1): 5557.
12.	蔡珍福, 王坚, 周玉坤, 等. 胆总管切开纤维胆道镜探查一期缝合695例分析 [J]. 肝胆胰外科杂志, 2004, 16(2): 110111.
13.	张光全, 吴先麟, 廖忠, 等. 胆总管一期缝合术(附350例报告) [J]. 肝胆胰外科杂志, 2008, 20(6): 420422.
14.	王志刚, 黄汉涛, 张英明, 等. 胆总管探查后一期缝合术中置鼻胆管引流术 [J]. 肝胆外科杂志, 2007, 15(2): 122124.
15.	裘丰, 王韦华, 严志龙, 等. 腹腔镜下一期切开缝合胆总管治疗胆总管结石 [J]. 肝胆胰外科杂志, 2004, 16(4): 283284.
16.	Alhamdani A, Mahmud S, Jameel M, et al. Primary closure of choledochotomy after emergency laparoscopic common bile duct exploration [J]. Surg Endosc, 2008, 22(10): 21902195.
17.	Yamazaki M, Yasuda H, Tsukamoto S, et al. Primary closure of the common bile duct in open laparotomy for common bile duct stones [J]. J Hepatobiliary Pancreat Surg, 2006, 13(5): 398402.
18.	Wani MA, Chowdri NA, Naqash SH, et al. Primary closure of the common duct over endonasobiliary drainage tubes [J]. World J Surg, 2005, 29(7): 865868.
19.	Ha JP, Tang CN, Siu WT, et al. Primary closure versus Ttube drainage after laparoscopic choledochotomy for common bile duct stones [J]. Hepatogastroenterology, 2004, 51(60): 16051608.
20.	Leida Z, Ping B, Shuguang W, et al. A randomized comparison of primary closure and Ttube drainage of the common bile duct after laparoscopic choledochotomy [J]. Surg Endosc, 2008, 22(7): 15951600.
21.	Huang SM, Yao CC, Cheng YW, et al. Laparoscopic primary closure of common bile duct combined with percutaneous cholangiographic drainage for treating choledocholithiasis [J]. Am Surg, 2010, 76(5): 517521.
22.	Ivanov D, Milosevi ＇c P. Primary closure of the common bile duct in the treatment of choledocholithiasis [J]. Med Pregl, 2010, 63(1): 99103.
23.	Tekin A, Ogetman Z. Laparoscopic exploration of the common bile duct with a rigid scope in patients with problematic choledocholithiasis [J]. World J Surg, 2010, 34(8): 18941899.
24.	Li LB, Cai XJ, Mou YP, et al. Reoperation of biliary tract by laparoscopy: experiences with 39 cases [J]. World J Gastroenterol, 2008, 14(19): 30813084.
25.	Jameel M, Darmas B, Baker AL. Trend towards primary closure following laparoscopic exploration of the common bile duct [J]. Ann R Coll Surg Engl, 2008, 90(1): 2935.
26.	Taylor CJ, Kong J, Ghusn M, et al. Laparoscopic bile duct exploration: results of 160 consecutive cases with 2year followup [J]. ANZ J Surg, 2007, 77(6): 440445.

1. Zhang WJ, Xu GF, Wu GZ, et al. Laparoscopic exploration of common bile duct with primary closure versus Ttube drainage: a randomized clinical trial [J]. J Surg Res, 2009, 157(1): e1e5.
2. Ahmed I, Pradhan C, Beckingham IJ, et al. Is a Ttube necessary after common bile duct exploration? [J]. World J Surg, 2008, 32(7): 14851488.
3. Ambreen M, Shaikh AR, Jamal A, et al. Primary closure versus Ttube drainage after open choledochotomy [J]. Asian J Surg, 2009, 32(1): 2125.
4. 孙利国, 刘小敏. 胆总管切开取石Ⅰ期缝合64例报道 [J]. 中国普外基础与临床杂志, 2007, 14(1): 109.
5. 田明国, 杨峻峰, 胡伟, 等. 胆总管探查切口一期缝合内支架引流术 [J]. 中国普通外科杂志, 2007, 16(2): 114116.
6. 周蒙滔, 孙洪伟, 金约朋, 等. 胆总管一期缝合术在胆道外科的应用 [J]. 肝胆胰外科杂志, 2009, 21(1): 3133.
7. Tan KK, Shelat VG, Liau KH, et al. Laparoscopic common bile duct exploration: our first 50 cases [J]. Ann Acad Med Singapore, 2010, 39(2): 136142.
8. Pawa N, Tutton MG. Primary common bile duct closure is safe following emergency and elective exploration [J]. World J Surg, 2009, 33(8): 1779.
9. Zhu QD, Tao CL, Zhou MT, et al. Primary closure versus Ttube drainage after common bile duct exploration for choledocholithiasis [J]. Langenbecks Arch Surg, 2010, 14(5):844848.
10. 王毅本, 曾小兵, 吴驰, 等. 胆总管探查后一期缝合胆汁漏的临床分析 [J]. 中国普外基础与临床杂志, 2005, 12(4): 351352, 360.
11. 许龙堂, 郑樟栋, 陈凯, 等. 胆总管探查后一期缝合的临床问题探讨 [J]. 中华肝胆外科杂志, 1998, 4(1): 5557.
12. 蔡珍福, 王坚, 周玉坤, 等. 胆总管切开纤维胆道镜探查一期缝合695例分析 [J]. 肝胆胰外科杂志, 2004, 16(2): 110111.
13. 张光全, 吴先麟, 廖忠, 等. 胆总管一期缝合术(附350例报告) [J]. 肝胆胰外科杂志, 2008, 20(6): 420422.
14. 王志刚, 黄汉涛, 张英明, 等. 胆总管探查后一期缝合术中置鼻胆管引流术 [J]. 肝胆外科杂志, 2007, 15(2): 122124.
15. 裘丰, 王韦华, 严志龙, 等. 腹腔镜下一期切开缝合胆总管治疗胆总管结石 [J]. 肝胆胰外科杂志, 2004, 16(4): 283284.
16. Alhamdani A, Mahmud S, Jameel M, et al. Primary closure of choledochotomy after emergency laparoscopic common bile duct exploration [J]. Surg Endosc, 2008, 22(10): 21902195.
17. Yamazaki M, Yasuda H, Tsukamoto S, et al. Primary closure of the common bile duct in open laparotomy for common bile duct stones [J]. J Hepatobiliary Pancreat Surg, 2006, 13(5): 398402.
18. Wani MA, Chowdri NA, Naqash SH, et al. Primary closure of the common duct over endonasobiliary drainage tubes [J]. World J Surg, 2005, 29(7): 865868.
19. Ha JP, Tang CN, Siu WT, et al. Primary closure versus Ttube drainage after laparoscopic choledochotomy for common bile duct stones [J]. Hepatogastroenterology, 2004, 51(60): 16051608.
20. Leida Z, Ping B, Shuguang W, et al. A randomized comparison of primary closure and Ttube drainage of the common bile duct after laparoscopic choledochotomy [J]. Surg Endosc, 2008, 22(7): 15951600.
21. Huang SM, Yao CC, Cheng YW, et al. Laparoscopic primary closure of common bile duct combined with percutaneous cholangiographic drainage for treating choledocholithiasis [J]. Am Surg, 2010, 76(5): 517521.
22. Ivanov D, Milosevi ＇c P. Primary closure of the common bile duct in the treatment of choledocholithiasis [J]. Med Pregl, 2010, 63(1): 99103.
23. Tekin A, Ogetman Z. Laparoscopic exploration of the common bile duct with a rigid scope in patients with problematic choledocholithiasis [J]. World J Surg, 2010, 34(8): 18941899.
24. Li LB, Cai XJ, Mou YP, et al. Reoperation of biliary tract by laparoscopy: experiences with 39 cases [J]. World J Gastroenterol, 2008, 14(19): 30813084.
25. Jameel M, Darmas B, Baker AL. Trend towards primary closure following laparoscopic exploration of the common bile duct [J]. Ann R Coll Surg Engl, 2008, 90(1): 2935.
26. Taylor CJ, Kong J, Ghusn M, et al. Laparoscopic bile duct exploration: results of 160 consecutive cases with 2year followup [J]. ANZ J Surg, 2007, 77(6): 440445.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Study on Indications and Clinical Experience of Primary Suture after Common Bile Duct Exploration

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