Comparative Study of Three Common Bile Duct Closure Techniques
关键词
抽象
描述
At present, the commonest available options for CBD closure include repair over T-tube drain, primary closure and repair after antegrade biliary stenting. All three methods present specific technical performance features, require different postoperative management protocols, and are charged with specific morbidity related to the procedure and therefore should not be considered exactly the same procedure in the context of LCBDE.
Repair over T-tube is the traditional surgical technique. It has many advantages as post-operative distal CBD decompression, trans-tubal cholangiography, and availability of retained CBD stones extraction. However, it has a number of potential complications up to 10% of patients. The most frequent complications are bile leakage, tract infection, T-tube dislodgement, electrolyte and nutritional disturbances, cholangitis, or acute renal failure from dehydration due to inadequate water ingestion. It also causes discomfort and persistent pain to the patient along with increased hospital admission and thus economic burden to the country. Primary closure of CBD has been described in literature to overcome these adverse consequences of the T-tube. However, it has a number of potential complications as a potential bile leak and CBD stricture which may occur owing to papillary edema and insufficient bile duct expansion. There are conflicting results regarding significant differences in the morbidity and mortality between primary closure and T-tube drainage. There is no conclusive evidence displaying whether primary closure is better or worse than T-tube drainage after CBD exploration.
In order to decrease the two complications, using biliary stent in primary closure is an effective method, which can reduce biliary pressure without bile loss. Although, there are some available drainage options after LCBDE, a consensus on the optimal drainage is yet to be reached.
日期
最后验证: | 03/31/2020 |
首次提交: | 02/06/2020 |
提交的预估入学人数: | 02/06/2020 |
首次发布: | 02/10/2020 |
上次提交的更新: | 04/02/2020 |
最近更新发布: | 04/06/2020 |
实际学习开始日期: | 12/31/2016 |
预计主要完成日期: | 12/31/2019 |
预计完成日期: | 06/30/2020 |
状况或疾病
干预/治疗
Procedure: T tube drainage
Procedure: Primary closure
Procedure: Antegrade stenting
相
手臂组
臂 | 干预/治疗 |
---|---|
Active Comparator: T tube drainage Closure of common bile duct after choledocholithotomy over T tube | |
Experimental: Primary closure Primary closure of the common bile duct after choledocholithotomy | |
Experimental: Antegrade stenting Closure of common bile duct over antegrade biliary plastic stent |
资格标准
有资格学习的年龄 | 20 Years 至 20 Years |
有资格学习的性别 | All |
接受健康志愿者 | 是 |
标准 | Inclusion criteria - CBD stones - age from 20 to 80, - CBD > 0.8 cm and < 2.5 cm, - American Society of Anesthesiologists (ASA) grade I, II or III, - agreement to randomization and complete the study requirement. Exclusion criteria - acute suppurative cholangitis, - acute biliary pancreatitis, - biliary malignancy, - biliary malformation, - distal CBD stenosis and or obstruction, - trans-cystic stone extraction, - explorations followed by choledochojejunostomy and choledochoduodenostomy. |
结果
主要结果指标
1. Perioperative morbidity [30 days]
2. Perioperative mortality [10 days]
次要成果指标
1. Wound infection [10 days]
2. Persistent biliary fistula [30 days]
3. Operative time [2 Hours]
4. Hospital stay [4 days]
5. CBD stricture [6 month]