Skip to main content
SpringerLink
Log in

A randomized comparison of primary closure and T-tube drainage of the common bile duct after laparoscopic choledochotomy

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Traditionally, the common bile duct (CBD) has been closed with T-tube drainage after laparoscopic choledochotomy and removal of CBD stones. However, insertion of the T-tube is related to some potential postoperative complications, and patients must carry the T-tube for several weeks before its removal. Primary closure of the CBD without drainage has been proposed as a safe alternative to T-tube placement after laparoscopic choledochotomy. This randomized study aimed to compare the postoperative course and final outcome between the two methods applied after LCBDE.

Methods

Between January 2000 and January 2004, 80 patients treated with laparoscopic choledochotomy for CBD stones were randomly assigned to primary duct closure (n = 40) or T-tube drainage (n = 40). The primary end points were morbidity, operative time, postoperative stay, hospital expenses, and time until return to work.

Results

There were no differences in the demographic characteristics or clinical presentations between the two groups. In the primary closure group, the postoperative stay (5.2 ± 2.2 vs 8.3 ± 3.6 days) and the time until return to work (12.6 ± 5.1 vs 20.4 ± 13.2 days) were significantly shorter, the hospital expenses (8,638 ± 2,946 vs 12,531 ± 4,352 yuan) were significantly lower, and the incidences of postoperative complications (15% vs 27.5%) and biliary complications (10% vs 20%) were statistically and insignificantly lower than in the T-tube drainage group. In the primary closure group, six patients experienced postoperative complications, four of whom had biliary complications, compared, respectively, with 11 and 8 patients in the T-tube drainage group.

Conclusions

This study showed that primary CBC closure after laparoscopic choledochotomy was a viable alternative to mandatory T-tube drainage.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Franklin ME Jr, Pharand D, Rosenthal D (1994) Laparoscopic common bile duct exploration. Surg Laparosc Endosc 4:119–124

    Article  Google Scholar 

  2. Rhodes M, Nathanson L, O’Rourke N, Fielding G (1995) Laparoscopic exploration of the common bile duct: lessons learned from 129 consecutive cases. Br J Surg 82:666–668

    Article  PubMed  CAS  Google Scholar 

  3. Rhodes M, Sussman L, Cohen L, Lewis MP (1998) Randomised trial of laparoscopic exploration of common bile duct versus postoperative endoscopic retrograde cholangiography for common bile duct stones. Lancet 351:159–161

    Article  PubMed  CAS  Google Scholar 

  4. 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

    PubMed  CAS  Google Scholar 

  5. Tokumura H, Umezawa A, Cao H, Sakamoto N, Imaoka Y, Ouchi A, Yamamoto K (2002) Laparoscopic management of common bile duct stones: transcystic approach and choledochotomy. J Hepatobiliary Pancreat Surg 9:206–212

    Article  PubMed  Google Scholar 

  6. 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

    Article  PubMed  CAS  Google Scholar 

  7. Cuschieri A, Lezoche E, Morino M, Croce E, Lacy A, Toouli J, Faggioni A, Ribeiro VM, Jakimowicz J, Visa J, Hanna GB (1999) EAES multicenter prospective randomized trial comparing two-stage vs single-stage management of patients with gallstone disease and ductal calculi. Surg Endosc 13:952–957

    Article  PubMed  CAS  Google Scholar 

  8. Bernstein DE, Goldberg RI, Unger SW (1994) Common bile duct obstruction following T-tube placement at laparoscopic cholecystectomy. Gastrointest Endosc 40:362–365

    Article  PubMed  CAS  Google Scholar 

  9. Ha JP, Tang CN, Siu WT, Chau CH, Li MK (2004) Primary closure versus T-tube drainage after laparoscopic choledochotomy for common bile duct stones. Hepatogastroenterology 51:1605–1608

    PubMed  CAS  Google Scholar 

  10. 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

    Article  PubMed  CAS  Google Scholar 

  11. De Roover D, Vanderveken M, Gerard Y (1989) Choledochotomy: primary closure versus T-tube: a prospective trial. Acta Chir Belg 89:320–324

    PubMed  Google Scholar 

  12. Paganini AM, Feliciotti F, Guerrieri M, Tamburini A, De Sanctis A, Campagnacci R, Lezoche E (2001) Laparoscopic common bile duct exploration. J Laparoendosc Adv Surg Tech A 11:391–400

    Article  PubMed  CAS  Google Scholar 

  13. Moreaux J (1995) Traditional surgical management of common bile duct stones: a prospective study during a 20-year experience. Am J Surg 169:220–226

    Article  PubMed  CAS  Google Scholar 

  14. Pappas TN, Slimane Brooks DC. Brooks DC (1990) 100 consecutive common duct explorations without mortality. Ann Surg 211: 260–262

    PubMed  CAS  Google Scholar 

  15. Sheridan WG, Williams HO, Lewis MH (1987) Morbidity and mortality of common bile duct exploration. Br J Surg 74:1095–1099

    Article  PubMed  CAS  Google Scholar 

  16. Cuschieri A, Croce E, Faggioni A, Jakimowicz J, Lacy A, Lezoche E, Morino M, Ribeiro VM, Toouli J, Visa J, Wayand W (1996) EAES ductal stone study. Preliminary findings of multi-center prospective randomized trial comparing two-stage vs single-stage management. Surg Endosc 10:1130–1135

    Article  PubMed  CAS  Google Scholar 

  17. Qi Wei, Hong-Jie Hhu, Xiao-Yan Cai, Wei Q, Hu HJ, Cai XY, Li LB, Wang GY (2004) Biliary drainage after laparoscopic choledochotomy. World J Gastroenterol 10:3175–3178

    Google Scholar 

  18. Kacker LK, Mittal BR, Sikora SS, Ali W, Kapoor VK, Saxena R, Das BK, Kaushik SP (1995) Bile leak after T-tube removal: a scintigraphic study. Hepatogastroenterology 42:975–978

    PubMed  CAS  Google Scholar 

  19. 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

    PubMed  CAS  Google Scholar 

  20. Gersin KS, Fanelli RD (1998) Laparoscopic endobiliary stenting as an adjunct to common bile duct exploration. Surg Endosc 12:301–304

    Article  PubMed  CAS  Google Scholar 

  21. Wills VL, Gibson K, Karihaloot C, Jorgensen JO (2002) Complications of biliary T-tubes after choledochotomy. ANZ J Surg 72:177–180

    Article  PubMed  Google Scholar 

  22. Halsted WS (1924) Surgical papers. Vol. 2. Johns Hopkins University Press, Baltimore, MD pp 427–472

    Google Scholar 

  23. Vassilakis JS, Chattopadhyay DK, Irvin TT, Duthie HL (1979) Primary closure of the common bile duct after elective choledochotomy. J R Coll Surg Edinb 24:156–158

    PubMed  CAS  Google Scholar 

  24. Sorensen VJ, Buck JR, Chung SK, Fath JJ, Horst HM, Obeid FN (1994) Primary common bile duct closure following exploration: an effective alternative to routine biliary drainage. Am Surg 60:451–454

    PubMed  CAS  Google Scholar 

  25. Williams JA, Treacy PJ, Sidey P, Worthley CS, Townsend NC, Russell EA (1994) Primary duct closure versus T-tube drainage following exploration of the common bile duct. Aust N Z J Surg 64:823–826

    Article  PubMed  CAS  Google Scholar 

  26. Kirkwood BR (1988) Essentials of medical statistics. Blackwell Science, Malden, USA

Download references

Author information

Authors and Affiliations

  1. Department of Hepatobiliary Surgery, Southwest Hospital, The Third Military Medical University, 30 Gaotanyan Main Street, Shapingba District, Chongqing, 400038, China

    Zhang Leida, Bie Ping, Wang Shuguang & He Yu

Authors
  1. Zhang Leida
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bie Ping
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wang Shuguang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. He Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zhang Leida.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Leida, Z., Ping, B., Shuguang, W. et al. A randomized comparison of primary closure and T-tube drainage of the common bile duct after laparoscopic choledochotomy. Surg Endosc 22, 1595–1600 (2008). https://doi.org/10.1007/s00464-007-9731-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-007-9731-9

Keywords

Search

Navigation