Introduction
Method
Patients
Patient inclusion criteria
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Preoperative abdominal ultrasonography and MRCP confirmed common bile duct stones combined with cholecystolithiasis.
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Patients without acute obstructive suppurative cholangitis.
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The patients underwent laparoscopic choledochotomy.
Patient exclusion criteria
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Patients converted to laparotomy.
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Patients with intrahepatic bile duct stones.
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Patients with common bile duct stenosis.
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Patients with biliary tract tumors.
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Children and pregnant women.
Ethical approval
The surgical procedure before suture of the common bile duct
Primary closure (backtracking full-thickness continuous everting suture)
T-tube biliary drainage
Developing propensity score
Statistics
Result
PSM model
Characteristics | Before PSM | After PSM | ||||||
---|---|---|---|---|---|---|---|---|
BFCE suture (n = 94) | T-tube drainage (n = 185) | χ2/Z | P | BFCE suture (n = 91) | T-tube drainage (n = 91) | χ2/Z | P | |
Gender [n(%)] | 4.296 | 0.038 | 0.09 | 0.765 | ||||
Male | 54(57.4) | 82(44.3) | 53(58.2) | 51(56.0) | ||||
Female | 40(42.6) | 103(55.7) | 38(41.8) | 40(44.0) | ||||
Age [M(P25,P75)] | 64(54,72) | 56(50.5,68) | -2.725 | 0.006 | 64(54,72) | 65(53,73) | -0.415 | 0.678 |
Preoperative Tbil [umol/L,M(P25,P75)] | 41.4(35.2,51.9) | 43.7(32.9,54.8) | -0.963 | 0.335 | 42.1(35.2,51.9) | 43.1(31.6,53.9) | -0.31 | 0.757 |
Preoperative hospital stay [d,M(P25,P75)] | 5(3,7) | 5(3,8) | -0.168 | 0.867 | 5(3,7) | 4(2,7) | -1.578 | 0.115 |
BMI[M(P25,P75)] | 26.8(22.5,30.8) | 27.9(22.6,31.5) | -0.879 | 0.379 | 27(22.5,30.8) | 27.8(22.4,31.2) | -0.256 | 0.798 |
ALB [g/L,M(P25,P75)] | 34.2(31.0,36.1) | 33.9(31.3,35.5) | -0.533 | 0.594 | 34.2(31.1,36.1) | 32.7(30.6,35.0) | -1.053 | 0.292 |
Common bile duct diameter [mm,M(P25,P75)] | 15.0(11.8,18.0) | 14.5(12.2,17.4) | -0.664 | 0.507 | 15(11.8,18.0) | 14.5(12.4,17.5) | -0.391 | 0.696 |
Hypertension [n(%)] | 1.085 | 0.298 | 0.034 | 0.854 | ||||
Positive | 20(21.3) | 30(16.2) | 19(20.9) | 18(19.8) | ||||
Negative | 74(78.7) | 155(83.8) | 72(79.1) | 73(80.2) | ||||
Coronary heart disease [n(%)] | 1.071 | 0.301 | 1.72 | 0.189 | ||||
Positive | 10(10.6) | 28(15.1) | 9(9.9) | 15(16.5) | ||||
Negative | 84(89.4) | 157(84.9) | 82(90.1) | 76(83.5) | ||||
Type 2 diabetes [n(%)] | 0.393 | 0.531 | 0.054 | 0.817 | ||||
Positive | 12(12.8) | 19(10.3) | 11(12.1) | 10(11.0) | ||||
Negative | 82(87.2) | 166(89.7) | 80(87.9) | 81(89.0) | ||||
Cerebral infarction [n(%)] | 0.179 | 0.672 | 0.028 | 0.867 | ||||
Positive | 24(25.5) | 43(23.2) | 24(26.4) | 25(27.5) | ||||
Negative | 70(74.5) | 142(76.8) | 67(73.6) | 66(72.5) | ||||
COPD [n(%)] | 2.737 | 0.098 | 0.871 | 0.351 | ||||
Positive | 8(8.5) | 7(3.8) | 7(7.7) | 4(4.4) | ||||
Negative | 86(91.5) | 178(96.2) | 84(92.3) | 87(95.6) | ||||
History of upper abdominal surgery [n(%)] | 0.777 | 0.378 | 2.643 | 0.104 | ||||
Positive | 17(18.1) | 26(14.1) | 15(16.5) | 24(26.4) | ||||
Negative | 77(81.9) | 159(85.9) | 76(83.5) | 67(73.6) |
Intraoperative clinical features
Characteristics | BFCE suture (n = 91) | T-tube drainage (n = 91) | χ2/Z | P |
---|---|---|---|---|
Intraoperative blood loss | 20(20,25) | 60(50,80) | -10.529 | < 0.000 |
Operation time [min,M(P25,P75)] | 120(100,140) | 120(110,140) | -2.202 | 0.028 |
Intestinal exhaust time [h,M(P25,P75)] | 13(11,16) | 22(20,26) | -10.685 | < 0.000 |
First activity time [h,M(P25,P75)] | 13(11,15) | 22(19,24) | -10.99 | < 0.000 |
Postoperative Tbil [umol/L,M(P25,P75)] | 20.3(16.1,23.6) | 19.8(16.4,23.7) | 0.124 | 0.901 |
Drainage tube removal time [h,M(P25,P75)] | 88(79,97) | 87(80,96) | -0.073 | 0.942 |
Postoperative return to work [h,M(P25,P75)] | 16(12,19) | 58(50,64) | -11.526 | < 0.000 |
Postoperative blood loss > 300 ml [n(%)] | ||||
Positive | 7(7.7) | 21(23.1) | ||
Negative | 84(92.3) | 70(76.9) | 8.273 | 0.004 |
Postoperative bile leakage [n(%)] | ||||
Positive | 7(7.7) | 9(9.9) | ||
Negative | 84(92.3) | 82(90.1) | 0.274 | 0.601 |
Pancreatitis [n(%)] | ||||
Positive | 5(5.5) | 15(16.5) | ||
Negative | 86(94.5) | 76(83.5) | 5.617 | 0.018 |
Bile duct sediment-like stones [n(%)] | ||||
Positive | 26(28.6) | 37(40.7) | ||
Negative | 65(71.4) | 54(59.3) | 2.937 | 0.087 |
Choledocholithiasis recurrence [n(%)] | ||||
Positive | 10(11.0) | 21(23.1) | ||
Negative | 81(89.0) | 70(76.9) | 4.705 | 0.03 |
The number of days in hospital [d,M(P25,P75)] | 16(13,19) | 18(14,23) | -2.931 | 0.033 |
Hospital costs [Yuan,M(P25,P75)] | 38,580(34,140,44,818) | 44,081(34,836,54,092) | -2.272 | 0.013 |
Postoperative paraclinical characteristics
Postoperative applications
Socioeconomic benefits
Postoperative common bile duct stone recurrence
Unplanned admission
Risk factors for biliary stone recurrence
Characteristics | Recurrence (n = 31) | No-recurrence (n = 151) | χ2 | P |
---|---|---|---|---|
Gender [n(%)] | ||||
Male | 17 (54.8) | 87 (57.6) | ||
Female | 14 (45.2) | 64 (42.4) | 0.081 | 0.776 |
Age [n(%)] | ||||
≥ 65 | 19 (61.3) | 66 (43.7) | ||
< 65 | 12 (38.7) | 85 (56.3) | 3.194 | 0.074 |
Preoperative Tbil [umol/L,n(%)] | ||||
≥ 43 | 20 (64.5) | 70 (46.4) | ||
< 43 | 11 (35.5) | 81 (53.6) | 3.393 | 0.065 |
BMI | ||||
≥ 24 | 27 (87.1) | 85 (56.3) | ||
< 24 | 4 (12.9) | 66 (43.7) | 10.312 | 0.001 |
ALB [g/L,n(%)] | ||||
≥ 33 | 18 (58.1) | 94 (62.3) | ||
< 33 | 13 (41.9) | 57 (37.7) | 0.191 | 0.662 |
Hypertension [n(%)] | ||||
Positive | 9 (29.0) | 28 (18.5) | ||
Negative | 22 (71.0) | 123 (81.5) | 1.747 | 0.186 |
Coronary heart disease [n(%)] | ||||
Positive | 5 (16.1) | 19 (12.6) | ||
Negative | 26 (83.9) | 132 (87.4) | 0.058 | 0.81 |
Type 2 diabetes [n(%)] | ||||
Positive | 2 (6.5) | 19 (12.6) | ||
Negative | 29 (93.5) | 132 (87.4) | 0.442 | 0.506 |
Cerebral infarction [n(%)] | ||||
Positive | 14 (45.2) | 35 (23.2) | ||
Negative | 17 (54.8) | 116 (76.8) | 6.317 | 0.012 |
COPD[n(%)] | ||||
Positive | 0 (0) | 11 (7.3) | ||
Negative | 31 (100) | 140 (92.7) | 1.292 | 0.256 |
History of upper abdominal surgery [n(%)] | ||||
Positive | 13 (41.9) | 26 (17.2) | ||
Negative | 18 (58.1) | 125 (82.8) | 9.333 | 0.002 |
Diameter of common bile duct [mm,n(%)] | ||||
≥ 15 | 23 (74.2) | 61 (40.4) | ||
< 15 | 8 (25.8) | 90 (59.6) | 11.821 | 0.001 |
Postoperative blood loss > 300 ml [n(%)] | ||||
Positive | 5 (16.1) | 23 (15.2) | ||
Negative | 26 (83.9) | 128 (84.8) | < 0.001 | > 0.999 |
Postoperative bile leakage [n(%)] | ||||
Positive | 3 (9.7) | 13 (8.6) | ||
Negative | 28 (90.3) | 138 (91.4) | < 0.001 | > 0.999 |
Pancreatitis [n(%)] | ||||
Positive | 3 (9.7) | 17 (11.3) | ||
Negative | 28 (90.3) | 134 (88.7) | < 0.001 | > 0.999 |
Complication [n(%)] | ||||
Positive | 6 (19.4) | 30 (19.9) | ||
Negative | 25 (80.6) | 121 (80.1) | 0.004 | 0.948 |
Bile duct sediment-like stones [n(%)] | ||||
Positive | 26 (83.9) | 37 (24.5) | ||
Negative | 5 (16.1) | 114 (75.5) | 40.052 | < 0.001 |
Pinaverium bromide (Oral administration) [n(%)] | ||||
Positive | 7 (22.6) | 78 (51.7) | ||
Negative | 24 (77.4) | 73 (48.3) | 8.735 | 0.003 |
Operation [n(%)] | ||||
Backtracking full-thickness continuous everting (BFCE) suture | 9 (29) | 81 (53.6) | ||
T-tube drainage | 22 (71) | 70 (46.4) | 6.232 | 0.013 |
Characteristics | b value | Standard deviation | Wald value | P | OR | 95% CI |
---|---|---|---|---|---|---|
Age ≥ 65 | 1.252 | 0.564 | 4.923 | 0.027 | 3.497 | 1.157~10.565 |
Preoperative Tbil ≥ 43umol/L | 1.363 | 0.563 | 5.859 | 0.015 | 3.908 | 1.296~11.783 |
BMI ≥ 24 | 1.493 | 0.674 | 4.9 | 0.027 | 4.45 | 1.187~16.688 |
History of upper abdominal surgery | 1.683 | 0.595 | 7.985 | 0.005 | 5.38 | 1.675~17.286 |
Bile duct sediment-like stones | 3.213 | 0.651 | 24.32 | < 0.001 | 24.849 | 6.931~89.095 |
Pinaverium bromide (Oral administration) | -1.488 | 0.591 | 6.345 | 0.012 | 0.226 | 0.071~0.719 |