Objective To explore cystic duct drainage in transumbilical laparoscopic common bile duct exploration through cystic duct common bile duct junction with primary closure. Methods A total of 225 patients with a diagnosis of cholecystolithiasis and choledocholithiasis who underwent transumbilical laparoscopic cholecystectomy and common bile duct exploration through cystic duct common bile duct junction with primary closure between August 2013 and October 2018 were retrospectively analyzed and the data were collected. Of these, 119 cases had bile drainage through cystic duct with primary closure as drainage group, while 106 cases had only primary closure as closure group. Operative time, abdominal drainage time, postoperative hospital stay, hospital cost and postoperative complications were compared between two groups. Results Abdominal drainage time, postoperative hospital stay and hospital cost in drainage group were significantly lower than those in closure group (P< 0.05). There was no significant difference in operative time between two groups (P>; 0.05). The rate of postoperative bile leak(8.40%) in drainage group was less than that (16.04%) in closure group and the difference was statistical significantly (P< 0.05). There was no other any complication in two groups. Conclusions Cystic duct drainage in transumbilical laparoscopic common bile duct exploration through cystic duct common bile duct junction with primary closure would be safe and effective.
XU Guoquan, GU Chunfei, YU Linhai, FENG Linsong, CHU Yongyue, ZHU Haifeng, FANG Shengli.
. Cyst duct drainage in laparoscopic common bile duct exploration with primary closure[J]. Journal of Surgery Concepts & Practice, 2019
, 24(03)
: 249
-253
.
DOI: 10.16139/j.1007-9610.2019.03.015
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