Primary closure of choledochotomy after emergency laparoscopic common bile duct exploration

The debate into whether or not to drain the common bile duct after laparoscopic common bile duct exploration (LCBDE) for choledocholithiasis continues. Reports are in favour of primary closure of choledochotomy in elective setting. The aim of this study is to evaluate our experience in the primary closure of choledochotomy in emergency setting by analysing indications, operative time, hospital stay, complications, and outcome.

All patients undergoing LCBDE were prospectively entered into a database incorporating demographic and clinical data including mode of admission, indication for surgery, operation details and clinical outcome. All operations were performed by the same consultant (A. Baker).

All 81 patients had primary closure after LCBDE between October 2003 and April 2007. The male to female ratio was 1:3. Median age was 68 years (range 19-90 years). Nineteen (23%) patients had obstructive jaundice, 4 (5%) had cholangitis, 7 (8.6%) had acute pancreatitis, 9 (11.1%) had failed ERCP, and 42 (51.8%) had biliary colic or cholecystitis with positive intraoperative cholangiogram (IOC). Those patients were divided into two groups: elective LCBDE (ElLCBDE) (n=33, 41%) and emergency LCBDE (EmLCBDE) (n=48, 59%). There was no significant difference in the median operative time, median hospital stay and complication rate. Total laparoscopic clearance rate in this series was 95%.

To our knowledge, this is the first publication in the literature in which primary closure after laparoscopic common bile duct exploration in emergency setting was used. With no significant difference in operative time, hospital stay and complications, in experienced hands primary closure of CBD in emergency settings is safe and feasible.