Surgical Endoscopy

, Volume 29, Issue 5, pp 1094–1098 | Cite as

Use of biliary stent in laparoscopic common bile duct exploration

  • Matthew Lyon
  • Seema Menon
  • Abhiney Jain
  • Harish Kumar
Article

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.

Keywords

T-tube Choledocholithiasis Choledochotomy General surgery Common bile duct (CBD) Biliary stent 

References

  1. 1.
    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 13:952–957CrossRefPubMedGoogle Scholar
  2. 2.
    Martin DJ, Vernon DR, Toouli J (2006) Surgical versus endoscopic treatment of bile duct stones. Cochrane database of systematic reviews (Online)(2): CD003327Google Scholar
  3. 3.
    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 351:159–161CrossRefPubMedGoogle Scholar
  4. 4.
    Tranter SE, Thompson MH (2002) Comparison of endoscopic sphincterotomy and laparoscopic exploration of the common bile duct. Br J Surg 89:1495–1504CrossRefPubMedGoogle Scholar
  5. 5.
    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 228:29–34CrossRefPubMedCentralPubMedGoogle Scholar
  6. 6.
    Huang J, Zhu J (2009) Spontaneously removed endobiliary J stent drainage after laparoscopic common bile duct exploration. Surg Endosc 23:1398–1402CrossRefPubMedGoogle Scholar
  7. 7.
    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 13:300–306CrossRefPubMedGoogle Scholar
  8. 8.
    Wu JS, Soper NJ (2002) Comparison of laparoscopic choledochotomy closure techniques. Surg Endosc 16:1309–1313CrossRefPubMedGoogle Scholar
  9. 9.
    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:CD005640Google Scholar
  10. 10.
    Kelly MD (2010) Results of laparoscopic bile duct exploration via choledochotomy. Aust N Z J Surg 80:694–698CrossRefGoogle Scholar
  11. 11.
    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 157:1–5CrossRefGoogle Scholar
  12. 12.
    El-Geidie AAR (2010) Is the use of t-tube necessary after laparoscopic choledochotomy? J Gastrointest Surg 14:844–848CrossRefPubMedGoogle Scholar
  13. 13.
    Jameel M, Darmas B, Baker AL (2008) Trend towards primary closure following laparoscopic exploration of the common bile duct. Ann R Coll Surg Engl 90:29–35CrossRefPubMedCentralPubMedGoogle Scholar
  14. 14.
    Griniatsos J, Karvounis E, Arbuckle J, Isla AM (2005) Cost-effective method for laparoscopic choledochotomy. Aust N Z J Surg 75:35–38CrossRefGoogle Scholar
  15. 15.
    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 27:4164–4170CrossRefPubMedGoogle Scholar
  16. 16.
    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 257:54–66CrossRefPubMedGoogle Scholar
  17. 17.
    Isla AM, Griniatsos J, Karvounis E, Arbuckle JD (2004) Advantages of laparoscopic stented choledochorrhaphy over T-tube placement. Br J Surg 91:862–866CrossRefPubMedGoogle Scholar
  18. 18.
    Cushieri A (2007) Laparoscopic bilde duct surgery: home truths. J min Access Surg 3:1–2CrossRefGoogle Scholar
  19. 19.
    DeRoover D, Vanderveken M, Gerard Y (1989) Choledochotomy: primary closure vs T-tube. A prospective trial. Acta Chir Belg 89:320–324Google Scholar
  20. 20.
    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 29:869–872CrossRefPubMedGoogle Scholar
  21. 21.
    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 10:1064–1068CrossRefPubMedGoogle Scholar
  22. 22.
    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 12:933–935CrossRefPubMedGoogle Scholar
  23. 23.
    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 57:1034–1036PubMedGoogle Scholar
  24. 24.
    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 22:345–348CrossRefGoogle Scholar
  25. 25.
    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 53:330–334PubMedGoogle Scholar
  26. 26.
    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 20:807–811CrossRefGoogle Scholar
  27. 27.
    Gersin KS, Fanelli RD (1998) Laparoscopic endobiliary stenting as an adjunct to common bile duct exploration. Surg Endosc 12:301–304CrossRefPubMedGoogle Scholar
  28. 28.
    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 16:487–491CrossRefPubMedGoogle Scholar
  29. 29.
    Johanson JF, Schmalz MJ, Greenen JE (1992) Incidence and risk factors for biliary and pancreatic stent migration. Gastrointest Endosc 38:341–346CrossRefPubMedGoogle Scholar
  30. 30.
    Lenzo NP, Garas G (1998) Biliary stent migration with colonic diverticular perforation. Gastrointest Endosc 47:543–544CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Matthew Lyon
    • 1
    • 2
  • Seema Menon
    • 1
  • Abhiney Jain
    • 3
  • Harish Kumar
    • 1
    • 2
  1. 1.Department of Surgery Darling Downs Health ServiceQueensland HealthToowoombaAustralia
  2. 2.The School of Medicine - Rural Clinical SchoolThe University of QueenslandBrisbaneAustralia
  3. 3.Whittington HealthNHS TrustLondonUK

Personalised recommendations