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World Journal of Surgery

, 35:2283 | Cite as

Sphincter of Oddi-preserving and T-Tube-free Laparoscopic Management of Extrahepatic Bile Duct Calculi

  • Chun-Chih Chen
  • Shuo-Dong WuEmail author
  • Yu Tian
  • Ernest Amos Siwo
  • Xin-Tao Zeng
  • Guang-Hui Zhang
Article

Abstract

Background

The current management of choledocholithiasis remains a controversial topic. Popular options for treatment include preoperative endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (EST) followed by laparoscopic cholecystectomy (LC), or LC and laparoscopic common bile duct exploration (LCBDE) with T-tube decompression. Some concerns suggest that sphincterotomy has significant long-term complications as a result of sphincter of Oddi (SO) dysfunction, and T-tube decompression is historically associated with many complications and discomfort. The purpose of this study was to demonstrate our simple, safe techniques of LCBDE without a T-tube and with an intact SO.

Methods

Between April 2006 and July 2009, a total of 44 selected patients with common bile duct (CBD) stones underwent laparoscopic exploration at our institution. Of 44 laparoscopic choledochotomies, primary choledochorrhaphy was performed on patients with preoperatively installed endoscopic retrograde biliary drainage (ERBD) tubes (n = 10, 22.73%) or endonasobiliary drainage (ENBD) tubes (n = 10, 22.73%) and on patients with intraoperative biliary drainage C-tubes (n = 9, 20.45%) or pigtail J biliary drainage tubes (n = 15, 34.09%).

Results

The mean operating time for the ENBD, ERBD, J-tube, and C-tube groups were 97.8, 96.2, 102.1, and 98.7 min, respectively. There were no conversions to open surgery, and no intraoperative complications were experienced in any group. CBD clearance was achieved in 43 patients (97.73%). The mean lengths of follow-up for the ENBD, ERBD, J-tube, and C-tube groups were 27.0, 26.7, 23.8, and 30.4 months, respectively; and none of the patients developed major biliary complications including recurrent stones.

Conclusions

Laparoscopic primary closure with internal and external biliary drainage tubes is safe and an effective alternative to T-tube placement, especially for younger patient groups able to endure bile duct exploration. Sphincter of Oddi function is well preserved to prevent recurrent bile duct stones and bile duct cancer. Procedures are safe with great feasibility.

Keywords

Common Bile Duct Common Bile Duct Stone Bile Duct Cancer Residual Stone Common Bile Duct Exploration 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Société Internationale de Chirurgie 2011

Authors and Affiliations

  • Chun-Chih Chen
    • 1
  • Shuo-Dong Wu
    • 1
    Email author
  • Yu Tian
    • 1
  • Ernest Amos Siwo
    • 1
  • Xin-Tao Zeng
    • 1
  • Guang-Hui Zhang
    • 1
  1. 1.Department of Biliary and Vascular SurgeryShengJing Hospital of China Medical UniversityShenyangPeople’s Republic of China

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