A Retrospective Study on the Three-Port Technique of Laparoscopic Common Bile Duct Exploration for the Management of Cholelithiasis and Choledocholithiasis

Figures & data

Figure 1 Management of LCBDE with the three-port method. (A) The Trocars chosen for LCBDE were 5 mm, 10 mm, and 10 mm, respectively. (B) The three Trocars were placed corresponding to the ports. (C and D) A suitable drainage tube was placed through the 5-mm port on the right upper quadrant.

Figure 2 Removal of CBD stones through choledocholithotomy. (A) The anterior wall of the CBD was cut directly approximately 10–15 mm after (B) 4–0 absorbable thread was used to suspend the anterior wall longitudinally. The CBD was explored via choledochoscopy.

Figure 3 Primary continuous suture of CBD. (A and B) The CBD incision was sutured with the 4–0 absorbable thread via a continuous round-trip approach.

Figure 4 Flow diagram.

Table 1 Characteristic and Clinical Features of Patients

Items	LCBDE-P (n=50)	LCBDE-T (n=38)	P-value
Gender (M/F)			0.107
Male	19(38.0%)	21(55.3%)
Female	31(62.0%)	17(44.7%)
Age (years)	58.880 ±13.752	61.763±13.13	0.295
Body weight (kg)	61.980±10.125	63.311±11.832	0.504
WBC (10^9/L)	5.995±2.870	6.889±2.447	0.111
Bellyache	35(70.0%)	27(71.1%)	0.915
Combined gastrointestinal ulcer	3(6.0%)	3(7.9%)	0.938
Pancreatitis	3(6.0%)	3(7.9%)	0.938
Cholangitis	17(34.0%)	18(47.4%)	0.204
Obstructive jaundice	12(24.0%)	16(42.1%)	0.071
Fever	5(10.0%)	6(15.8%)	0.626
Nausea and/or Vomit	14(28.0%)	11(28.9%)	0.922
DB (µmol/L)	18.087±25.441	28.074±29.267	0.071
TB (µmol/L)	31.565±53.371	39.571±31.958	0.370
ALT (U/L)	152.100±199.539	167.711±160.780	0.485
AST (U/L)	92.320±121.217	98.237±106.067	0.579

Abbreviations: LCBDE-P, laparoscopic common bile duct exploration+primary suturing of the common bile duct; LCBDE-T, laparoscopic common bile duct exploration+T-tube drainage of common bile duct; M, male; F, female; WBC, white blood cell; DB, direct bilirubin; TB, total bilirubin; ALT, alanine aminotransferase; AST, aspartate aminotransferase.

Table 2 Analysis of the Intraoperative Characteristics

Items	LCBDE-P (n=50)	LCBDE-T (n=38)	P-value
Operation time (min)	130.940±52.548	146.895±50.549	0.160
Intraoperative hemorrhage (mL)	20.000±12.570	33.947±77.342	0.219
Clearance rate of CBD stones (%)	100	100	-
Stone subtype of CBD stones			0.263
Solitary (<3)	25(50.0%)	16(42.1%)
Multiple (≥3)	18(36.0%)	21(55.3)
Sediment-like	7(14.0%)	1(2.6%)

Abbreviations: LCBDE-P, laparoscopic common bile duct exploration+primary suturing of the common bile duct; LCBDE-T, laparoscopic common bile duct exploration+T-tube drainage of common bile duct; CBD, common bile duct.

Table 3 Analysis for the Characteristics of Postoperative Liver Function in All Patients

Items	LCBDE-P (n=50)	LCBDE-T (n=38)	P-value
ΔDB	8.385±19.767	2.902±21.674	0.234
ΔTB	14.960±51.501	3.501±27.621	0.234
ΔALT	72.449±139.997	84.889±108.220	0.662
ΔAST	51.551±101.866	44.250±84.366	0.730

Note: Δ, preoperative value−the postoperative value on day 3.

Abbreviations: LCBDE-P, laparoscopic common bile duct exploration+primary suturing of the common bile duct; LCBDE-T, laparoscopic common bile duct exploration+T-tube drainage of common bile duct; DB, direct bilirubin; TB, total bilirubin.

Table 4 Economic Benefits of LCBDE-P vs LCBDE-T

Items	LCBDE-P (n=50)	LCBDE-T (n=38)	P-value
Hospitalization (days)	14.120±4.376	21.105±7.451	<0.001
Medical Cost (RMB 10K)	2.060±0.434	2.733±0.673	<0.001

Note: P-values less than 0.001, was boldly marked, indicated statistical significance.

Abbreviations: LCBDE-P, laparoscopic common bile duct exploration+primary suturing of the common bile duct; LCBDE-T, laparoscopic common bile duct exploration+T-tube drainage of common bile duct; RMB, Ren Min Bi; 10K, 10 thousand Yuan.

Table 5 Postoperative Complications of LCBDE-P vs LCBDE-T

Items	LCBDE-P (n=50)	LCBDE-T (n=38)	P-value
Hemorrhage	0(0.0%)	0(0.0%)	-
Bile leakage	0(0.0%)	2(5.3%)	0.184
Abdominal infection	0(0.0%)	1(2.6%)	0.432
Cholangitis	0(0.0%)	2(5.3%)	0.184
Pancreatitis	0(0.0%)	0(0.0%)	-
Retained CBD stone	0(0.0%)	0(0.0%)	-

Abbreviations: LCBDE-P, laparoscopic common bile duct exploration+primary suturing of the common bile duct; LCBDE-T, laparoscopic common bile duct exploration+T-tube drainage of common bile duct.

Table 6 Univariable and Multivariable Analysis for the Length of Stay in All Patients

	Univariable		Multivariable
	OR (95% CI)	P-value	OR (95% CI)	P-value
LCBDE-P vs LCBDE-T	0.104 (0.038–0.280)	<0.001	0.115 (0.040–0.329)	<0.001
Age	1.022 (0.990–1.055)	0.173
Gender	2.100 (0.894–4.933)	0.089
Body weight	1.008 (0.970–1.048)	0.677
Preoperative white blood cells	1.313 (1.049–1.644)	0.017	1.179 (0.926–1.503)	0.182
Preoperative total bilirubin	1.001 (0.992–1.010)	0.874
Preoperative direct bilirubin	1.013 (0.996–1.030)	0.127
Preoperative ALT	1.001 (0.998–1.003)	0.582
Preoperative AST	1.002 (0.998–1.006)	0.325
Operative time	1.014 (1.004–1.024)	0.005	1.011 (1.001–1.021)	0.033
Intraoperative hemorrhage	1.007 (0.989–1.025)	0.467
Postoperative complications	1,777,022,351.004 (0.00–∞)	0.999
Stone subtype	0.539 (0.274–1.060)	0.073

Abbreviations: LCBDE-P, laparoscopic common bile duct exploration+primary suturing of the common bile duct; LCBDE-T, laparoscopic common bile duct exploration+T-tube drainage of common bile duct; ALT, alanine aminotransferase; AST, aspartate aminotransferase; OR odds ratio, CI confidence interval. P-values less than 0.05 or 0.001, was boldly marked, indicated statistical significance.

Table 7 Univariable and Multivariable Analysis for Medical Cost During Hospitalization

	Univariable		Multivariable
	OR (95% CI)	P-value	OR (95% CI)	P-value
LCBDE-P vs LCBDE-T	0.104 (0.038–0.280)	<0.001	0.120 (0.041–0.357)	<0.001
Age	1.026 (0.994–1.059)	0.115
Gender	2.544 (1.073–6.028)	0.034	0.925 (0.285–3.003)	0.896
Body weight	1.017 (0.978–1.058)	0.396
Preoperative white blood cells	1.360 (1.075–1.720)	0.010	1.215 (0.926–1.593)	0.160
Preoperative total bilirubin	1.005 (0.995–1.016)	0.326
Preoperative direct bilirubin	1.025 (1.005–1.046)	0.016	1.020 (0.998–1.042)	0.072
Preoperative ALT	1.001 (0.999–1.004)	0.237
Preoperative AST	1.003 (0.999–1.007)	0.151
Operative time	1.014 (1.004–1.024)	0.004	1.011 (1.000–1.022)	0.040
Intraoperative hemorrhage	1.008 (0.987–1.029)	0.475
Postoperative complications	1,777,022,350.96 (0.00–∞)	0.999
Stone subtype	0.679 (0.351–1.313)	0.250

Note: P-values less than 0.05 or 0.001, was boldly marked, indicated statistical significance.

Abbreviations: LCBDE-P, laparoscopic common bile duct exploration+primary suturing of the common bile duct; LCBDE-T, laparoscopic common bile duct exploration+T-tube drainage of common bile duct; ALT, alanine aminotransferase; AST, aspartate aminotransferase; OR, odds ratio; CI, confidence interval.