Abstract
Introduction
It is well supported in the literature that laparoscopic common bile duct exploration (LCBDE) for choledocholithiasis has equal efficacy when compared to ERCP followed by laparoscopic cholecystectomy. Decompression after supra-duodenal choledochotomy is common practice as it reduced the risk of bile leaks. We conducted a prospective non-randomized study to compare outcomes and length of stay in patients undergoing biliary stent insertion versus T-tube drainage following LCBDE via choledochotomy.
Methods and procedures
The study involved 116 patients with choledocholithiasis who underwent LCBDE and decompression of the biliary system by either ante-grade biliary stent or T-tube insertion. A 7 French straight/duodenal curve biliary Diagmed™ stent (9–11 cm) was placed in 82 patients (Biliary Stent Group). T-tube insertion was used for 34 patients (T-tube group). The length of hospital stay and complications for the selected patients were recorded. All trans-cystic common bile duct explorations were excluded from the study.
Results
The mean hospital stay for patients who underwent ante-grade biliary stent or T-tube insertion after LBCDE were 1 and 3.4 days, respectively. This is a statistically significant result with a p value of less than 0.001. Of the T-tube group, two patients required laparoscopic washout due to bile leaks, one had ongoing biliary stasis and one reported ongoing pain whilst the T-tube was in situ. A complication rate of 11.2 %, this was a significant finding. There were no complications or concerns reported for the Biliary Stent Group.
Conclusion
Our results show that there is a significant reduction in length of hospital stay and morbidity for patients that have ante-grade biliary stent decompression of the CBD post laparoscopic choledochotomy when compared T-tube drainage. This implies that ante-grade biliary stent insertion is likely to reduce costs and increase overall patient satisfaction. We support the use of ante-grade biliary stent insertion during LCBDE when primary closure is not preferred.
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References
Cuschieri A, Lezoche E, Morino M, Croce E, Lacy A, Toouli J, Hanna GB (1999) E.A.E.S. multicenter prospective randomized trial comparing two-stage vs single-stage management of patients with gallstone disease and ductal calculi. Surg Endosc 13:952–957
Martin DJ, Vernon DR, Toouli J (2006) Surgical versus endoscopic treatment of bile duct stones. Cochrane database of systematic reviews (Online)(2): CD003327
Rhodes M, Sussman I, Cohen L, Lewis MP (1998) Randomised trial of laparoscopic exploration of the common bile duct versus postoperative endoscopic retrograde cholangiography for common bile duct stones. Lancet 351:159–161
Tranter SE, Thompson MH (2002) Comparison of endoscopic sphincterotomy and laparoscopic exploration of the common bile duct. Br J Surg 89:1495–1504
Martin IJ, Bailey IS, Rhodes M, O’Rourke N, Nathanson L, Fielding G (1998) Towards T-tube free laparoscopic bile duct exploration: a methodologic evolution during 300 consecutive procedures. Ann Surg 228:29–34
Huang J, Zhu J (2009) Spontaneously removed endobiliary J stent drainage after laparoscopic common bile duct exploration. Surg Endosc 23:1398–1402
Holdsworth RJ, Sadek SA, Ambikar S, Cuschieri A, Becker JM (1989) Dynamics of bile flow through the human choledochal sphincter following exploration of the common bile duct. World J Surg 13:300–306
Wu JS, Soper NJ (2002) Comparison of laparoscopic choledochotomy closure techniques. Surg Endosc 16:1309–1313
Gurusamy KS, Koti R, Davidson BR (2013) T-tube drainage versus primary closure after open common bile duct exploration. The Cochrane Database of Systematic Reviews 6:CD005640
Kelly MD (2010) Results of laparoscopic bile duct exploration via choledochotomy. Aust N Z J Surg 80:694–698
Zhang WJ, Xu GF, WuG Z, Li JM, Dong ZT, Mo XD (2009) Laparoscopic exploration of common bile duct with primary closure versus T-tube drainage: a randomized clinical trial. J Surg Res 157:1–5
El-Geidie AAR (2010) Is the use of t-tube necessary after laparoscopic choledochotomy? J Gastrointest Surg 14:844–848
Jameel M, Darmas B, Baker AL (2008) Trend towards primary closure following laparoscopic exploration of the common bile duct. Ann R Coll Surg Engl 90:29–35
Griniatsos J, Karvounis E, Arbuckle J, Isla AM (2005) Cost-effective method for laparoscopic choledochotomy. Aust N Z J Surg 75:35–38
Khaled YS, Malde DJ, De Souza C, Kalia A, Ammori BJ (2013) Laparoscopic bile duct exploration via choledochotomy followed by primary duct closure is feasible and safe for the treatment of choledocholithiasis. Surg Endosc 27:4164–4170
Yin Z, Xu K, Sun J, Zhang J, Xiao Z, Wang J, Li Y (2013) Is the end of the T-tube drainage era in laparoscopic choledochotomy for common bile duct stones is coming? A systematic review and meta-analysis. Ann Surg 257:54–66
Isla AM, Griniatsos J, Karvounis E, Arbuckle JD (2004) Advantages of laparoscopic stented choledochorrhaphy over T-tube placement. Br J Surg 91:862–866
Cushieri A (2007) Laparoscopic bilde duct surgery: home truths. J min Access Surg 3:1–2
DeRoover D, Vanderveken M, Gerard Y (1989) Choledochotomy: primary closure vs T-tube. A prospective trial. Acta Chir Belg 89:320–324
Perez G, Escalona A, Jarufe N, Ibanez L, Viviani P, Garcia C, Salvado J (2005) Prospective randomized study of T-tube versus biliary stent for common bile duct decompression after open choledocotomy. World J Surg 29:869–872
Croce E, Golia M, Azzola M, Russo R, Crozzoli L, Olm S (1996) Laparoscopic choledochotomy with primary closure. Follow-up (5–44 months) of 31 patients. Surg Endosc 10:1064–1068
DePaula AL, Hashiba K, Bafutto M, Machado C, Ferrari A, Machado MM (1998) Results of the routine use of a modified endoprosthesis to drain the common bile duct after laparoscopic choledochotomy. Surg Endosc 12:933–935
Kuroki T, Tajima Y, Tsuneoka N, Kitasato A, Adachi T, Kosaka T, Kanematsu T (2010) Placement of a plastic biliary stent tube with primary closure of the common bile duct after laparoscopic common bile duct exploration. Hepatogastroenterology 57:1034–1036
Mangla V, Chander J, Vindal A, Lal P, Ramteke VK (2012) A randomized trial comparing the use of endobiliary stent and T-tube for biliary decompression after laparoscopic common bile duct exploration. Surg Laparosc 22:345–348
Tang CN, Tai CK, Ha JPY, Tsui KK, Wong DCT, Li MKW (2006) Antegrade biliary stenting versus T-tube drainage after laparoscopic choledochotomy—a comparative cohort study. Hepatogastroenterology 53:330–334
Chen CC, Wu SD, Tian Y, Zeng XT, Siwo EA, Xian GZ (2010) The fading role of T-tube in laparoscopic choledochotomy: primary choledochorrhaphy and over pigtail j and endonasobiliary drainage tubes. J Laparoendosc Adv Surg Tech 20:807–811
Gersin KS, Fanelli RD (1998) Laparoscopic endobiliary stenting as an adjunct to common bile duct exploration. Surg Endosc 12:301–304
Fanelli RD, Gersin KS, Mainelia MT (2002) Laparoscopic endobiliary stenting significantly improves success of post operatve endoscopic retrograde choladngiopancreatography in low volume centres. Surg Endosc 16:487–491
Johanson JF, Schmalz MJ, Greenen JE (1992) Incidence and risk factors for biliary and pancreatic stent migration. Gastrointest Endosc 38:341–346
Lenzo NP, Garas G (1998) Biliary stent migration with colonic diverticular perforation. Gastrointest Endosc 47:543–544
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Matthew Lyon, Seema Menon, Abhiney Jain and Harish Kumar have no conflicts of interest or financial ties to disclose.
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Lyon, M., Menon, S., Jain, A. et al. Use of biliary stent in laparoscopic common bile duct exploration. Surg Endosc 29, 1094–1098 (2015). https://doi.org/10.1007/s00464-014-3797-y
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DOI: https://doi.org/10.1007/s00464-014-3797-y