Comparison of primary duct closure versus T-tube drainage in laparoscopic common bile duct exploration: a propensity score matching analysis.

Abstract

Background and aims: Laparoscopic common bile duct exploration (LCBDE) is a safe and effective method for the treatment of choledocholithiasis. However, there is still controversy in clinical practice over whether primary duct closure (PDC) or T-tube drainage (TTD) should be selected after choledochotomy. Therefore, this study aimed to compare the two methods of closing the common bile duct in order to identify the safer and more effective approach.

Approach and results: A retrospective analysis was conducted on data from 745 patients who underwent LCBDE at the Department of Hepatobiliary and Pancreatic Surgery, Zhongshan Hospital, Xiamen University, between January 2017 and December 2021. Using propensity score matching (PSM), 433 patients were selected and divided into two groups: the primary duct closure group (PDC group, 287 patients) and the T-tube drainage group (TTD group, 146 patients). The study compared preoperative baseline characteristics, Intraoperative conditions, and postoperative conditions between the two groups. The results showed that the PDC group had significantly shorter operative time and less intraoperative blood loss compared to the TTD group, along with a lower incidence of postoperative infections. Despite no significant differences between the two groups in terms of postoperative hospital stay, bile leakage, biliary stricture, residual stones, postoperative bleeding, and recurrence, the overall performance of the PDC group was superior to that of the TTD group.

Conclusion: The study concluded that primary duct closure (PDC) after LCBDE is safer and more effective than T-tube drainage (TTD), without increasing the risk of postoperative complications.