Efficacy of primary closure versus T-tube drainage in patients with common bile duct stones after laparoscopic common bile duct exploration and stone extraction
Objective To investigate the efficacy of primary closure versus T-tube drainage in patients with common bile duct stones after laparoscopic common bile duct exploration and stone extraction.Methods Fifty-two patients with common bile duct stones who received treatment at The Second Affiliated Hospital of Guizhou Medical University between February 2021 and February 2023 were included in this study.All patients underwent laparoscopic common bile duct exploration and stone extraction and then were divided into two groups(n=26 per group)using a randomized controlled trial design with allocation based on a random number table.The control group received T-tube drainage postoperatively,whereas the observation group underwent primary suture treatment.Both groups were observed for 3 days postoperatively to compare various postoperative clinical indicators,including serum levels of cortisol,adrenaline,C-reactive protein,interleukin-6,direct bilirubin,total bile acid,alkaline phosphatase,and gamma-glutamyl transferase,and the occurrence of postoperative complications.Results The operative time in the observation group was significantly shorter than that in the control group[(105.30±5.89)minutes vs.(121.36±5.86)minutes,t=9.86,P＜0.001].The intraoperative blood loss in the observation group was significantly less than that in the control group[(40.31±4.53)mL vs.(45.20±4.76)mL,t=3.80,P＜0.001].The length of hospital stay in the observation group was significantly shorter than that in the control group[(12.01±2.86)days vs.(14.32±2.73)days,t=2.98,P=0.005].The gastrointestinal function recovery time in the observation group was shorter than that in the control group[(31.42±2.59)days vs.(37.62±2.63)days,t=8.57,P＜0.001].The bile drainage volume in the observation group was less than that in the control group[(168.69±15.41)mL vs.(275.62±15.32)mL,t=25.09,P＜0.001].The serum level of cortisol in the observation group was significantly higher than that in the control group[(469.63±20.62)mmol/L vs.(359.65±19.87)mmol/L,t=19.58,P＜0.001].The serum level of adrenaline in the observation group was significantly higher than that in the control group[(274.62±20.21)ng/L vs.(198.64±20.16)ng/L,t=13.57,P＜0.001].The serum level of C-reactive protein in the observation group was significantly higher than that in the control group[(3.42±0.37)mg/L vs.(2.74±0.25)mg/L,t=7.77,P＜0.001].The serum level of interleukin-6 in the observation group was significantly higher than that in the control group[(112.36±8.94)μg/L vs.(87,62±8.63)μg/L,t=10.15,P＜0.001].The serum level of direct bilirubin in the observation group was significantly lower than that in the control group[(24.52±4.62)μmol/L vs.(35.62±4.87)μmol/L,t=8.43,P＜0.001].The serum level of total bile acid in the observation group was significantly lower than that in the control group[(10.62±4.21)U/L vs.(17.64±4.16)U/L,t=6.05,P＜0.001].The serum level of alkaline phosphatase in the observation group was significantly lower than that in the control group[(100.21±10.24)mg/L vs.(112.74±11.25)mg/L,t=4.20,P＜0.001].The serum level of gamma-glutamyl transferase in the observation group was significantly lower than that in the control group[(122.36±8.94)μg/L vs.(142.62±5.63)μg/L,t=9.78,P＜0.001].The incidence of complications in the observation group was significantly lower than that in the control group[7.69％(2/26)vs.30.77％(8/26),x2=4.46,P=0.035].Conclusion Compared with T-tube drainage,primary closure following laparoscopic common bile duct exploration and stone extraction can reduce patient stress responses,improve liver function,shorten postoperative recovery time,and result in a lower incidence of complications.
CholedocholithiasisCholecystectomy,laparoscopicSuture techniquesDrainageStress disorders,traumaticLiver function testsRandomized controlled trialPostoperative complications
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