Abstract
Background
The T-tube is widely used in laparoscopic choledochotomy to decompress the biliary tree. However, there are high morbidity rates related to the T-tube. This study reviewed the results of laparoscopic primary choledochorrhaphy over endonasobiliary drainage (ENBD) tubes to find an effective alternative to the T-tube for the performance of laparoscopic choledochotomy.
Methods
From March 2003 to September 2005, 23 patients (9 men and 14 women) with choledocholithiasis underwent laparoscopic choledochotomy over ENBD tubes. The mean age of these patients was 47 years (range, 32–73 years). At admission, six patients had cholangitis. All the patients had ENBD tubes placed preoperatively after the failure of endoscopic sphincterotomy.
Results
There was no conversion to open surgery. The mean operative time was 90 min (range, 70–150 min). There were no biliary complications such as bile leaks, biliary peritonitis, or pancreatitis. No residual stones were found by postoperative cholangiograms. The ENBD tubes were removed between postoperative days 7 and 9. The hospital stay ranged from 8 to 14 days, with 16 patients (70%) discharged on postoperative day 8. The complications were limited to one umbilical infection and one case of pneumonia. The median follow-up period was 24 months (range, 8–36 months), and none of the patients were readmitted with biliary symptoms.
Conclusion
Laparoscopic choledochotomy over ENBD tubes proved to be technically feasible and safe. The ENBD tube decompresses the biliary tree and allows for cholangiography after surgery. Its removal does not need to wait for tract maturation, which allows an earlier removal of the tube and a shorter postoperative hospital stay. Laparoscopic choledochotomy over ENBD tubes is an effective alternative to the T-tube in laparoscopic choledochotomy.
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References
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
Decker G, Borie F, Millat B, Berthou JC, Deleuze A, Drouard F, Guillon F, Rodier JG, Fingerhut A (2003) One hundred laparoscopic choledochotomies with primary closure of the common bile duct. Surg Endosc 17: 12–18
Gersin KS, Fanelli RD (1998) Laparoscopic endobiliary stenting as an adjunct to common bile duct exploration. Surg Endosc 12: 301–304
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
Fujimura M, Hirano M, Sato I, Kinoshita T, Yamamoto I, Nishimura K, Takahara H, Yamamoto A (2000) The C tube in biliary surgery: its development and clinical application. Nippon Geka Hokan 68: 85–122
Berthou JC, Drouard F, Charbonneau P, Moussalier K (1997) Evaluation of laparoscopic management of common bile duct stones in 220 patients. Surg Endosc 12: 16–22
Thompson MH, Tranter SE (2002) All-comers policy for laparoscopic exploration of the common bile duct. Br J Surg 89: 1608–1612
Vecchio R, MacFadyen BV (2002) Laparoscopic common bile duct exploration. Langenbecks Arch Surg 387: 45–54
Berci G, Morgenstern L (1994) Laparoscopic management of common bile duct stones: a multi-institutional SAGES study. Surg Endosc 8: 1168–1175
European Association of Endoscopic Surgeons Ductal Stone Cooperative Group (1996) EAES ductal stone study: preliminary findings of multicenter prospective randomized trial comparing two-stage vs single-stage management. Surg Endosc 10: 1130–1135
Berthou JC, Drouard F, Charbonneau P, Moussalier K (1997) Evaluation of laparoscopic management of common bile duct stones in 220 patients. Surg Endosc 12: 16–22
Millat B, Atger J, Deleuze A, Briandet H, Fingerhut A, Guillon F, Marrel E, De Seguin C, Soulier P (1997) Laparoscopic treatment for choledocholithiasis: a prospective evaluation in 247 consecutive unselected patients. Hepatogastroenterology 44: 28–34
Mosimann F, Schneider R, Mir A, Gillet M (1994) Erosion of the duodenum by a biliary T-tube: an unusual complication of liver transplantation. Transplant Proc 26: 3550–3551
Ortega Lopez D, Ortiz Oshiro E, La Pena Gutierrez L, Martinez Sarmiento J, Sobrino del Riego JA, Alvarez Fernandez-Represa J (1995) Scintigraphic detection of biliary fistula after removal of a T-tube. Br J Surg 82: 82
Corbett CR, Fyfe NC, Nicholls RJ, Jackson RT (1986) Bile peritonitis after removal of T-tubes from the common bile duct. Br J Surg 73: 641–643
Gharaibeh KIA, Heiss HA (2000) Biliary leakage following T-tube removal. Int Surg 85: 57–63
Croce E, Golia M, Azzola M, Russo R, Crozzoli L, Olmi S, Pompa C, Borzio M (1996) Laparoscopic choledochotomy with primary closure: follow-up (5–44 months) of 31 patients. Surg Endosc 10: 1064–1068
Wu JS, Soper NJ (2002) Comparison of laparoscopic choledochotomy closure techniques. Surg Endosc 16: 1309–1313
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 Endosc12: 933–935
Xu L, Zhang Z, Chen K, Wu R, Mao G, Luo J, Zhang J, Zhang H, Zeng T (2002) Primary common bile duct closure after choledochotomy. Zhonghua Wai Ke Za Zhi 40: 927–929
Zhang LD, Bie P, Chen P, Wang SG, Ma KS, Donf JH (2004) Primary duct closure versus T-tube drainage following laparoscopic choledochotomy. Zhonghua Wai Ke Za Zhi 42: 520–523
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Zhang, HF., Hu, SY., Zhang, GY. et al. Laparoscopic primary choledochorrhaphy over endonasobiliary drainage tubes. Surg Endosc 21, 2115–2117 (2007). https://doi.org/10.1007/s00464-007-9299-4
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DOI: https://doi.org/10.1007/s00464-007-9299-4