eISSN: 2299-0054
ISSN: 1895-4588
Videosurgery and Other Miniinvasive Techniques
Current issue Archive Manuscripts accepted About the journal Supplements Editorial board Reviewers Abstracting and indexing Subscription Contact Instructions for authors Ethical standards and procedures
Editorial System
Submit your Manuscript
SCImago Journal & Country Rank
vol. 18
General surgery
Original paper

Is T-tube drainage no longer needed for laparoscopic common bile duct exploration? A retrospective analysis and literature review

Wangcheng Xie
Weidi Yu
Zhou Zhang
Zhilong Ma
Zhenshun Song
Tingsong Yang

Department of General Surgery, Shanghai Tenth People’s Hospital, Tongji University, School of Medicine, Shanghai, China
Department of General Surgery, Yangpu District Shidong Hospital, Shanghai, China
Department of General Surgery, Tongren Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
Videosurgery Miniinv 2023; 18 (1): 99–107
Online publish date: 2022/10/27
Article file
- Is T-tube drainage.pdf  [0.55 MB]
Get citation
PlumX metrics:


Choledocholithiasis is the second most prevalent complication of cholecystolithiasis, which accounts for approximately 3–16% of patients with gallstones [1]. Additionally, prompt medical attention is recommended for patients with symptomatic choledocholithiasis to avoid life-threating acute cholangitis, biliary pancreatitis and severe inflammation [2].

The standard care for choledocholithiasis remains debatable. At present, endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy is considered as a mainstream method for choledocholithiasis [3]. However, laparoscopic common bile duct exploration (LCBDE) has increasingly been proven to be a safer and more effective method in recent years, with fewer short-term and long-term complications [4]. In particular, as a one-stage procedure, LCBDE with bile duct primary closure (PC) also has the advantages of faster postoperative recovery, shorter hospital stay and lower costs [57].

Traditionally, T-tube drainage (TTD) has been widely applied in laparoscopic or open choledochotomy, which not only can decompress the biliary tree and reduce the risk of bile leak and biliary stricture, but also can provide the access for cholangiography to detect and remove the residual stones [8, 9]. However, the rate of complications related to TTD is also as high as approximately 15%, which can prolong the hospital stay and increase the expenses [10]. Thus, the indications to determine in which situation we should choose the way of bile duct closure, TTD or PC, following LCBDE, is worth discussion.


In this study, we aimed to evaluate the safety and efficacy of PC and TTD following LCBDE, and discuss the indications of methods of selection for bile duct closure combined with a literature review.

Material and methods

Patients and data collection

From January 2014 to February 2019, a collected database of 826 patients who underwent LCBDE at Shanghai Tenth People’s Hospital was reviewed. LCBDE was performed for patients with a diagnosis of choledocholithiasis confirmed by preoperative computed tomography (CT), magnetic resonance cholangiopancreatography (MRCP), and/or abdominal ultrasonography. The clinical data, such as demographic information, clinical symptoms, characteristics of stone, dimeters of common bile duct (CBD), medical history, operative process, methods of bile duct closure, and postoperative outcomes, were recorded and analyzed.

The stones were classified into two categories according to their location: one for common bile duct stones and the second for ‘other’, the latter being defined as stones located in the intrahepatic duct, common hepatic duct or cystic duct stones. 30-day readmission indicated that the patient was readmitted to the hospital within 30 days of discharge, except for the reason of removing the T-tube. Mortality was defined as the patients who died during hospitalization or within 30 days of discharge. The expenses of the T-tube drainage group included two parts: LCBDE and T-tube removal. Operative complications were classified with the Clavien-Dindo classification system [11, 12]. Recurrence was defined as the stone rediscovered more than 6 months after LCBDE, and the diagnosis depends on imaging examination [13].

This study was approved by the Institutional Review Board of Shanghai Tenth People’s Hospital (SHSY-IEC-4.1/21-143/01).

Operative technique

The operative technique for LCBDE was as described previously, using the “four-port and six-step” approach under general anesthesia [14, 15]. Briefly, after successfully dissecting Calot’s triangle, the cystic duct was isolated and clamped with an absorbable clip (Lapro-Clip; Tyco Healthcare, Covidien, Norwalk, Conn., USA), which prevented the gallbladder stones sliding into the CBD during the operation. Then, the CBD was fully exposed and the choledochoscope was used to detect and remove stones following longitudinal choledochotomy. A Dormia basket (FG-24X-1; Olympus), high-pressured saline irrigation, and/or laser lithotripsy (World of Medicine, Berlin, Germany) were selectively used to extract stones. After confirmation of clearance of the bile duct stones, the bile duct was closed with absorbable 4-0 PDS II sutures (Ethicon Inc., Somerville, NJ, USA) in continuous over-and-over locking fashion or dwelling T-tube drainage. After ensuring no bile leakage from the CBD incision, the gallbladder was removed routinely. A silicone drainage tube was routinely placed in the foramen of Winslow.

Statistical analysis

Statistical analyses were performed with SPSS version 26.0 (IBM Corporation, Armonk, NY, USA) and R software version 4.0.4 (R Project for Statistical Computing, Vienna, Austria). Student’s t-test or the Mann-Whitney U test was applied for the analysis of quantitative variables, which were presented as mean ± SD or median (quartiles); the χ2 test or Fisher’s exact test was used for comparing qualitative variables, which were reported as frequencies with percentages. Propensity score matching (PSM) at a 1 : 1 ratio was utilized to reduce significant imbalances in baseline characteristics. Matching was performed for baseline characteristics including demographic and preoperative data, using a caliper width of 0.05. Kaplan-Meier curves depicting the cumulative recurrence probability were constructed to compare long-term outcomes between different groups. In addition, linear regression and Cox proportional-hazards regression were conducted to further reduce bias. A p-value of < 0.05 was considered statistically significant.


During the research period, a total of 826 participants who underwent LCBDE were included and reviewed. Demographic and preoperative characteristics are shown in Table I.

Table I

Baseline characteristics of all LCBDE patients

ParameterTotal (n = 826)PC (n = 796)TTD (n = 30)P-value
Follow-up time [months]38.02 (27.70, 53.51)38.21 (27.83, 53.53)30.68 (24.28, 52.03)0.152
Sex, female, n (%)449 (54.36)436 (54.77)13 (43.33)0.217
Age [years]63.00 (55.00, 72.00)63.00 (55.00, 72.00)65.50 (59.00, 74.25)0.236
BMI [kg/m2]23.42 ±3.1723.44 ±3.1522.88 ±3.800.343
Symptoms, n (%):
 Abdominal pain743 (89.95)721 (90.58)22 (73.33)0.006
 Jaundice222 (26.88)205 (25.75)17 (56.67)< 0.001
 Cholecystitis617 (74.70)596 (74.87)21 (70.00)0.547
 Cholangitis272 (32.93)257 (32.29)15 (50.00)0.043
 Pancreatitis32 (3.87)30 (3.77)2 (6.67)0.745
CBD diameter [mm]11.00 (10.00, 12.00)11.00 (10.00, 12.00)12.00 (11.00, 14.25)0.006
CBD stone, n (%):
 Size ≥ 15 mm77 (9.32)69 (8.72)8 (26.67)0.003
 Number ≥ 3279 (33.78)262 (33.08)17 (56.67)0.007
 Location, other34 (4.12)27 (3.39)7 (23.33)< 0.001
 Impaction67 (8.11)60 (7.54)7 (23.33)0.006
 Mirizzi syndrome7 (0.85)6 (0.75)1 (3.33)0.229
Serum liver biochemical indicators:
 ALT [U/l]92.35 (22.53, 254.83)94.05 (22.00, 256.63)53.00 (34.30, 164.95)0.627
 AST [U/l]53.40 (22.80, 149.70)53.20 (22.50, 150.20)53.80 (25.75, 122.80)0.929
 GGT [U/l]266.10 (70.80, 506.55)262.70 (64.35, 503.65)336.30 (139.85, 607.90)0.169
 ALP [U/l]142.75 (88.23, 233.65)141.70 (88.08, 227.45)211.05 (118.83, 330.25)0.017
 TBIL [μmol/l]21.70 (12.80, 57.25)21.50 (12.60, 55.50)33.25 (14.68, 99.18)0.036
 DBIL [μmol/l]9.10 (4.30, 36.70)9.00 (4.25, 35.70)22.30 (6.48, 74.50)0.009
Operative treatment process, n (%):
 Abdominal adhesion694 (84.02)670 (84.17)24 (80.00)0.720
 Post-cholecystectomy50 (6.05)46 (5.78)4 (13.33)0.189
 Post-ERCP35 (4.24)33 (4.15)2 (6.67)0.833
 Laser lithotripsy31 (3.75)23 (2.89)8 (26.67)< 0.001
Comorbidities and past history, n (%):
 Hypotension415 (50.24)397 (49.87)18 (60.00)0.276
 Diabetes138 (16.71)131 (16.46)7 (23.33)0.322
 Coronary heart disease58 (7.02)57 (7.16)1 (3.33)0.659
 Fatty liver154 (18.64)148 (18.59)6 (20.00)0.846
 Viral hepatitis477 (57.75)458 (57.54)19 (63.33)0.528
 Urinary calculus96 (11.62)94 (11.81)2 (6.67)0.567

[i] ALP – antileukoproteinase, ALT – alanine aminotransferase, AST – aspartate aminotransferase, BMI – body mass index, CBD – common bile duct, DBIL – direct bilirubin, ERCP – endoscopic retrograde cholangiopancreatography, GGT – γ-glutamyltranspeptidase, LCBDE – laparoscopic common bile duct exploration, PC – primary closure, TBIL – total bilirubin, TTD – T-tube drainage.

Of these patients, 796 were treated with PC, and the most frequent clinical symptoms were abdominal pain (90.58%), cholecystitis (74.87%), cholangitis (32.39%), jaundice (25.75%), and pancreatitis (3.77%). For characteristics of stones, the size ≥ 15 mm was noted in 8.72%, the number ≥ 3 in 33.08%, another location in 3.39%, impaction in 7.54%, and Mirizzi syndrome in 0.75%. The median CBD diameter was 11.00 mm, ranging from 5 to 35 mm. In addition, about 5.78% of the patients had undergone cholecystectomy, and 4.15% had experienced a failed ERCP before LCBDE.

The operative outcomes of patients with PC are summarized in Table II. Only 7 (0.88%) patients were temporarily converted to open surgery intraoperatively for dense adhesion, unclear anatomy and Mirizzi syndrome. The median operative time was 111.00 min, and median blood loss was 20.00 ml. Bile leakage occurred in 28 (3.52%) patients, and all patients were treated by conservative management, including drainage and intravenous antibiotics. The median postoperative stay and drainage time were 6.00 days and 5.00 days. In summary, there were few serious postoperative complications after LCBDE with PC, and surgery-related death was not observed. After a long-term follow-up with the median at 38.21 months, recurrent stones were detected in 37 (4.65%) patients without any bile duct stricture events.

Table II

Outcomes of patients undergoing primary closure

VariablePC (n = 796)
Conversion to open surgery, n (%)7 (0.88)
Operative time [min]111.00 (87.00, 144.00)
Blood loss [ml]20.00 (20.00, 50.00)
Bile leakage, n (%)28 (3.52)
SSSI, n (%)1 (0.13)
Perforation, n (%)1 (0.13)
Postoperative stay [days]6.00 (5.00,8.00)
Postoperative drainage time [days]5.00 (4.00,6.00)
30-day readmission, n (%)2 (0.25)
Second operation, n (%)2 (0.25)
Mortality, n (%)0 (0.00)
Clavien-Dindo classification, n (%):
 1763 (95.85)
 221 (2.64)
 3a5 (0.63)
 3b1 (0.13)
 4a6 (0.75)
 4b0 (0.00)
 50 (0.00)
Bile duct stricture, n (%)0 (0.00)
Recurrence, n (%)37 (4.65)

[i] PC – primary closure, SSSI – skin and skin structure infection.

T-tube drainage was indwelled in 30 patients. The clinical characteristics are summarized in Table I, which shows that TTD was performed in patients with a higher rate of jaundice (56.67%), cholangitis (50.00%), large stones (26.67%), multiple stones (56.67%), impacted stones (23.33%) and laser lithotripsy (26.67%). After PSM, 23 patients with PC and TTD were included and analyzed (Table III). The results showed that there were no significant differences between the two groups in blood loss, postoperative drainage time, bile leakage rate, 30-day readmission rate, complication rate, second operation rate and bile duct stricture rate. However, the operative time, postoperative stay and hospital expenses in the PC group were significantly shorter than in the TTD group (Table IV, Figure 1). The same results were obtained by univariate and multivariate linear regression analysis of the complete cohorts (Figure 2).

Table III

Baseline characteristics of patients after propensity score matching (PSM)

ParameterPC (n = 23)TTD (n = 23)P-value
Sex, female, n (%)12 (52.17)11 (47.83)0.768
Age [years]70.00 (65.00, 77.00)64.00 (59.00, 74.00)0.057
BMI [kg/m2]23.24 ±2.3123.35 ±3.500.898
Symptoms, n (%):
 Abdominal pain19 (82.61)18 (78.26)1.000
 Jaundice6 (26.09)11 (47.83)0.127
 Cholecystitis19 (82.61)17 (73.91)0.475
 Cholangitis12 (52.17)10 (43.48)0.555
 Pancreatitis0 (0.00)1 (4.35)1.000
CBD diameter [mm]12.00 (10.00, 15.00)12.00 (11.00, 14.00)0.902
CBD stone, n (%):
 Size ≥ 15 mm9 (39.19)6 (26.09)0.345
 Number ≥ 310 (43.48)13 (56.52)0.376
Location, other5 (21.74)5 (21.74)1.000
Impaction4 (17.39)6 (26.09)0.475
Mirizzi syndrome1 (4.35)1 (4.35)1.000
Serum liver biochemical indicators:
 ALT [U/l]49.40 (19.30, 185.10)42.80 (23.60, 168.40)0.701
 AST [U/l]41.00 (27.00, 132.40)53.40 (26.00, 108.00)0.921
 GGT [U/l]363.70 (56.80, 584.30)302.10 (105.00, 563.80)0.974
 ALP [U/l]196.00 (81.70, 374.80)170.60 (91.00, 270.50)0.835
 TBIL [μmol/l]17.20 (11.60, 41.70)24.20 (14.60, 99.00)0.184
 DBIL [μmol/l]8.30 (4.40, 31.90)13.50 (5.10, 69.00)0.160
Operative treatment process, n (%):
 Abdominal adhesion22 (95.65)19 (82.61)0.343
 Post-cholecystectomy3 (13.04)3 (13.04)1.000
Post-ERCP2 (8.70)2 (8.70)1.000
Laser lithotripsy5 (21.74)7 (30.43)0.502
Comorbidities and past history, n (%):
 Hypotension17 (73.91)13 (56.52)0.216
 Diabetes5 (21.74)5 (21.74)1.000
 Coronary heart disease0 (0.00)1 (4.34)1.000
 Fatty liver0 (0.00)4 (17.39)0.116
 Viral hepatitis15 (65.22)15 (65.22)1.000
 Urinary calculus1 (4.35)2 (8.70)1.000

[i] ALP – antileukoproteinase, ALT – alanine aminotransferase, AST – aspartate aminotransferase, BMI – body mass index, CBD – common bile duct, DBIL – direct bilirubin, ERCP – endoscopic retrograde cholangiopancreatography, GGT – γ-glutamyltranspeptidase, PC – primary closure, TBIL – total bilirubin, TTD – T-tube drainage.

Table IV

Outcomes between the primary closure and T-tube drainage group patients

VariablePC (n = 23)TTD (n = 23)P-value
Conversion to open surgery, n (%)0 (0.00)5 (21.74)0.058
Operative time [min]123.00 (86.75, 155.00)173.50 (125.00, 258.75)0.005
Blood loss [ml]20.00 (10.00, 50.00)50.00 (25.00, 100.00)0.111
Bile leakage, n (%)1 (4.34)0 (0.00)1.000
SSSI, n (%)0 (0.00)0 (0.00)1.000
Perforation, n (%)0 (0.00)0 (0.00)1.000
Postoperative stay [days]7.00 (6.00, 9.00)9.00 (8.00, 12.00)0.007
Postoperative drainage time [days]5.00 (4.00, 7.00)6.00 (5.00, 7.00)0.213
30-day readmission, n (%)0 (0.00)2 (8.70)0.470
Second operation, n (%)0 (0.00)2 (8.70)0.470
Mortality, n (%)0 (0.00)0 (0.00)1.000
Clavien-Dindo classification, n (%):0.103
 120 (86.95)18 (78.26)
 21 (4.35)4 (17.39)
 3a0 (0.00)1 (4.35)
 3b0 (0.00)0 (0.00)
 4a2 (8.70)0 (0.00)
 4b0 (0.00)0 (0.00)
 50 (0.00)0 (0.00)
Hospital expenses, $5235.07 (4730.26, 5539.07)5424.77 (5053.81, 6987.28)0.042
Bile duct stricture, n (%)0 (0.00)1 (4.34)1.000

[i] PC – primary closure, SSSI – skin and skin structure infection, TTD – T-tube drainage.

Figure 1

Operative time and postoperative stay between PC and TTD group. A – Operative time after PSM, B – operative time before PSM, C – postoperative stay after PSM, D – postoperative stay before PSM

PC – Primary closure, PSM – Propensity score matching, TTD – T-tube drainage. **P < 0.01, ****p < 0.0001.

Figure 2

Linear regression of operative time and postoperative stay regarding TTD, taking PC as reference

CI – confidence interval, PC – primary closure, TTD – T-tube drainage. ****P < 0.0001.


Kaplan-Meier curves and Cox proportional hazards regression were conducted to analyze the recurrence of bile duct stones. The Kaplan-Meier curves showed that the cumulative recurrence probabilities in the TTD group were higher than in the PC group, with the p-value being 0.002 (Figure 3). The crude and adjusted HR of Cox proportional hazards regression were 4.03 (95% CI: 1.58–10.25) and 3.56 (95% CI: 1.35–9.39) respectively (Figure 4).

Figure 3

Kaplan-Meier curves for the cumulative recurrence probabilities of bile duct stones in patients undergoing successful LCBDE

LCBDE – laparoscopic common bile duct exploration, PC – primary closure, TTD – T-tube drainage.

Figure 4

Cox proportional hazards regression of recurrence risk regarding TTD, taking PC as reference

CI – confidence interval, HR – hazard ratio, PC – primary closure, TTD – T-tube drainage. *P < 0.05, **p < 0.01.



In the past two decades years, ERCP was considered as a mainstream treatment for patients with common bile duct stones. However, with recent advances in laparoscopic technique, accumulating studies have demonstrated that LCBDE had a higher stone clearance rate, lower retained stone rate, lower lithiasis recurrence rate, shorter hospital stay and lower total charges than the ERCP procedure in these patients [4]. In addition, the LCBDE preserves the function of the sphincter of Oddi, which reduces the risk of refluxing cholangitis, pancreatitis and stone recurrence [16, 17]. Thus, the LCBDE procedure is increasingly becoming an optimal treatment choice for the patient with cholecysto-choledocholithiasis.

Our study also confirmed that LCBDE is effective and safe for the management of choledocholithiasis. In these patients, 96.37% of cases underwent primary closure, and T-tube drainage was inserted in only 3.63% of cases. The total successful stone clearance rate is 99.88% (data not shown). There was nearly no bile duct injury, hemorrhage, perforation or postoperative surgery related death. Postoperative bile leakage was 3.39% and all of the cases were managed successfully with conservation therapy (data not shown). The median follow-up period was 38.02 months, with evidence of bile duct stricture in only 1 patient.

Although LCBDE has proven safety and efficacy for the treatment of choledocholithiasis, and it was also included in the guidelines of the British Society of Gastroenterology, how to choose the method of common bile duct closure, primary closure or T-tube drainage remains debatable [2, 5]. Traditionally, open choledocholithotomy with T-tube drainage was the standard care for the treatment of choledocholithiasis. In the last twenty years, with the rapid development of minimally invasive laparoscopic surgical techniques, laparoscopic choledochotomy with T-tube drainage has been widely adopted in these patients [9]. The traditional viewpoint was that T-tube placement not only could decompress the biliary tree and reduce the risk of postoperative complications, such as bile leak and biliary stricture, but also could provide access to postoperatively detect and remove the residual stones by using cholangiography [8, 9].

However, we also noted that T-tube drainage not only caused tube-related complications, such as bile leakage, biliary peritonitis, T-tube displacement, bile duct obstruction, wound infection and skin excoriation around the T-tube, but also led to the patients experiencing loss of appetite, malnutrition and inconvenience in daily life, which also prolonged the hospital stay and recovery and increased hospital expenses [5, 6, 18].

Recently, with the advances in surgical instruments, technique, and knowledge, primary closure (PC) for common bile duct after LCBDE was preferentially recommended [19]. The results from several studies demonstrated that LCBDE with PC is a safe and effective method with shorter operating time, lower medical expenses, shorter postoperative hospital stay, and fewer postoperative complications than TTD [2022]. Additionally, PC can achieve the same rate of postoperative bile leakage and stone clearance compared with TTD and avoid the disadvantages associated with TTD [18, 19]. Exceptionally, our study demonstrated for the first time that primary closure would reduce the recurrence rate of bile duct stones and the T-tube is a potential factor that promotes stone formation [14, 23].

Based on previous studies, although T-tube drainage has numerous disadvantages and complications, it still has value for specific cases, such as acute suppurative cholangitis, multiple or large stones, suspicious residual stones, distal bile duct obstruction, when the biliary tract is thin, which would be beneficial in preventing bile leakage or bile duct strictures, or in providing access for removal of retained stones, or in providing effective biliary decompression in patients with incomplete stone removal after choledochotomy [8, 21, 24, 25]. Also, as shown in this study, a higher rate of T-tube drainage occurred in the patients with cholangitis, large stones, impacted stones and laser lithotripsy, which has a high rate of suspicious residual stones. Therefore, in our experience, TTD is also a valuable option if the patient presents with the above-mentioned conditions. Thus, although PC is preferred, many surgeons still believe in specific cases that the appropriate method of bile duct closure should be chosen based on the preoperative imaging manifestations, specific status of the bile duct, location and size of stones in the operation and the operator’s personal experience.

This study also had some limitations. First, it was a retrospective study with an inherent bias in data collection. Second, this was a single-center study, and the patient sample was relatively small. In particular, there were only 30 patients in the TTD group, which made the PSM matching less efficient. Third, we did not consider the patients’ peribiliary anatomical conditions, such as diverticula and common bile duct angulation. Therefore, further multi-center prospective studies with larger populations are necessary for further confirmation.


Primary closure following LCBDE is safe and effective in patients with choledocholithiasis. Although there are a variety of disadvantages for T-tube drainage, such as longer operative time, longer postoperative stay, higher hospital expenses and a higher recurrence rate, it still has value and is a safe alternative bile duct closure method in certain special cases, such as acute cholangitis, large stones, impacted stones and laser lithotripsy.


Wangcheng Xie, Weidi Yu, and Zhou Zhang contributed equally to this study.

Conflict of interest

The authors declare no conflict of interest.



European Association for the Study of the Liver (EASL). EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones. J Hepatol 2016; 65: 146-81.


Williams E, Beckingham I, El Sayed G, et al. Updated guideline on the management of common bile duct stones (CBDS). Gut 2017; 66: 765-82.


Bansal VK, Misra MC, Rajan K, et al. Single-stage laparoscopic common bile duct exploration and cholecystectomy versus two-stage endoscopic stone extraction followed by laparoscopic cholecystectomy for patients with concomitant gallbladder stones and common bile duct stones: a randomized controlled trial. Surg Endosc 2014; 28: 875-85.


Pan L, Chen M, Ji L, et al. The safety and efficacy of laparoscopic common bile duct exploration combined with cholecystectomy for the management of cholecysto-choledocholithiasis: an up-to-date meta-analysis. Ann Surg 2018; 268: 247-53.


Gurusamy KS, Koti R, Davidson BR. T-tube drainage versus primary closure after laparoscopic common bile duct exploration. Cochrane Database Syst Rev 2013; 6: CD005641.


Podda M, Polignano FM, Luhmann A, et al. Systematic review with meta-analysis of studies comparing primary duct closure and T-tube drainage after laparoscopic common bile duct exploration for choledocholithiasis. Surg Endosc 2016; 30: 845-61.


Zou Q, Ding Y, Li CS, et al. A randomized controlled trial of emergency LCBDE + LC and ERCP + LC in the treatment of choledocholithiasis with acute cholangitis. Videosurgery Miniinv 2022; 17: 156-62.


Cai H, Sun D, Sun Y, et al. Primary closure following laparoscopic common bile duct exploration combined with intraoperative cholangiography and choledochoscopy. World J Surg 2012; 36: 164-70.


Xiao LK, Xiang JF, Wu K, et al. The reasonable drainage option after laparoscopic common bile duct exploration for the treatment of choledocholithiasis. Clin Res Hepatol Gastroenterol 2018; 42: 564-9.


Wills V, Gibson K, Karihaloot C, et al. Complications of biliary T-tubes after choledochotomy. ANZ J Surg 2002; 72: 177-80.


Clavien PA, Sanabria JR, Strasberg SM. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery 1992; 111: 518-26.


Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240: 205-13.


Park SY, Hong TH, Lee SK, et al. Recurrence of common bile duct stones following laparoscopic common bile duct exploration: a multicenter study. J Hepatobiliary Pancreat Sci 2019; 26: 578-82.


Xie W, Yang T, Zhou X, et al. A nomogram for predicting stones recurrence in patients with bile duct stones undergoing laparoscopic common bile duct exploration. Ann Gastroenterol Surg 2022; 6: 543-54.


Ma Z, Zhou J, Yao L, et al. Safety and efficacy of laparoscopic common bile duct exploration for the patients with difficult biliary stones: 8 years of experiences at a single institution and literature review. Surg Endosc 2022; 36: 718-27.


Oliveira-Cunha M, Dennison AR, Garcea G. Late complications after endoscopic sphincterotomy. Surg Laparosc Endosc Percutan Tech 2016; 26: 1-5.


Zhang R, Luo H, Pan Y, et al. Rate of duodenal-biliary reflux increases in patients with recurrent common bile duct stones: evidence from barium meal examination. Gastrointest Endosc 2015; 82: 660-5.


Zhu T, Lin H, Sun J, et al. Primary duct closure versus T-tube drainage after laparoscopic common bile duct exploration: a meta-analysis. J Zhejiang Univ Sci B 2021; 22: 985-1001.


Deng Y, Tian HW, He LJ, et al. Can T-tube drainage be replaced by primary suture technique in laparoscopic common bile duct exploration? A meta-analysis of randomized controlled trials. Langenbecks Arch Surg 2020; 405: 1209-17.


Dong Z, Wu G, Luo K, et al. Primary closure after laparoscopic common bile duct exploration versus T-tube. J Surg Res 2014; 189: 249-54.


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. Surg Endosc 2008; 22: 1595-600.


Zhang H, Chen Y, Wu C, et al. Laparoscopic common bile duct exploration with primary closure for management of choledocholithiasis: a retrospective analysis and comparison with conventional T-tube drainage. Am Surg 2014; 80: 178-81.


Zhang J, Ling X. Risk factors and management of primary choledocholithiasis: a systematic review. ANZ J Surg 2020; 91: 530-6.


Jiang Y, Zhang J, Li W, et al. Primary closure versus T-tube drainage after laparoscopic common bile duct exploration in patients with non-severe acute cholangitis. Updates Surg 2022; 74: 899-906.


Zhang K, Zhan F, Zhang Y, et al. Primary closure following laparoscopic common bile duct reexploration for the patients who underwent prior biliary operation. Indian J Surg 2016; 78: 364-70.

Copyright: © 2022 Fundacja Videochirurgii This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (http://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
Quick links
© 2023 Termedia Sp. z o.o.
Developed by Bentus.