Immunogenic alteration in laparoscopic common bile duct exploration

Background: The immunologic benefits of laparoscopic common bile duct exploration (LCBDE) for choledocholithiasis are poorly understood. The aim of the present study was to investigate immunologic changes during LCBDE using primary suture or T-tube drainage. Methods: Patients with choledocholithiasis undergoing laparoscopic primary suture of the common bile duct after LCBDE (primary suture group) or laparoscopic LCBDE with choledochotomy plus T-tube drainage (T-tube group) at a single center between June 2008 and June 2011 were included in the present study. Blood samples were collected 24 h preoperatively, and 24 and 72 h postoperatively to assess interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-alpha) as inflammation markers. Immunosuppression was evaluated using C-reactive protein and leukocyte subpopulations. Results: Patients were 60 +/- 17 y old in the primary suture group (56 men and 76 women) and 54 +/- 20 y old in the T-tube group (50 men and 58 women). In the primary suture group, three patients (2.3%) required open surgery and six (4.5%) developed postoperative bile leakage. In the T-tube group, two patients (1.9%) required open surgery and four (3.7%) had bile leakage. Operation time and hospital stay were shorter in the primary suture group (P < 0.05). Postoperative TNF-alpha and lymphocyte counts were lower, and C-reactive protein and IL-6 levels were higher in the T-tube group compared with the primary suture group (P < 0.05). No recurrences or bile duct strictures were noted during follow-up (median of 12 mo). Conclusions: Laparoscopic primary suture techniques appear to reduce immunologic suppression by minimizing surgical trauma in patients with choledocholithiasis. Crown Copyright (C) 2014 Published by Elsevier Inc. All rights reserved.