T-tube in Moderation: T-tube Drainage versus Primary Closure after Open Common Bile Duct Exploration for Common Bile Duct Stone: A Single Institution Experience

Laparoscopic common bile duct exploration (LCBDE) has been recently introduced for management of CBD stone in patients with previous biliary surgery history. The aim of this study was to evaluate the safety and effectiveness of primary closure in patients with previous biliary surgery history compared to T-tube drainage. Eighty patients with previous biliary surgery history including laparoscopic cholecystectomy, open cholecystectomy, or open common bile duct exploration were enrolled in the retrospective study. The patients were divided into 2 groups according to the methods of choledochotomy closure. Group A: patients with primary closure after LCBDE (n = 51); group B: patients with T-tube drainage after LCBDE (n = 29). Group A exhibited a shorter postoperative hospital stay and lower hospitalization expenses compared to group B. There was no significant difference in conversion rate to open surgery, operating time, intraoperative blood loss, bile leakage rate, overall complication rate, and stone recurrence rate between the 2 groups. Biliary stricture was not observed in the 2 groups during the follow-up period. Primary closure following LCBDE is safe and effective for the management of CBD stones in patients with previous biliary surgery history.

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Laparoscopic Common Bile Duct Exploration with Primary Closure for Management of Choledocholithiasis: A Retrospective Analysis and Comparison with Conventional T-tube Drainage

The American Surgeon ◽

10.1177/000313481408000227 ◽

2014 ◽

Vol 80 (2) ◽

pp. 178-181 ◽

Cited By ~ 23

Author(s):

Hong-Wei Zhang ◽

Ya-Jin Chen ◽

Chang-Hao Wu ◽

Wen-Da Li

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Hospital Stay ◽

Primary Closure ◽

Bile Leakage ◽

Common Bile Duct Exploration ◽

Tube Drainage ◽

T Tube ◽

Group A ◽

Group B

Laparoscopic common bile duct exploration (LCBDE) had become one of the main options for management of choledocholithiasis. This retrospective comparative study aimed to evaluate on the feasibility and advantages of primary closure versus conventional T-tube drainage of the common bile duct (CBD) after laparoscopic choledochotomy. In this retrospective analysis, 100 patients (47 men and 53 women) with choledocholithiasis who underwent primary closure of the CBD (without T-tube drainage) after LCBDE (Group A) were compared with 92 patients who underwent LCBDE with T-tube drainage (Group B). Both groups were evaluated with regard to biliary complications, hospital stay, and recurrence of stones. The mean operation time was 104.12 minutes for Group A and 108.92 minutes for Group B ( P = 0.069). The hospital stay was significantly shorter in Group A than that in Group B (6.95 days and 12.05 days, respectively; P < 0.001). In Group A, bile leakage occurred in two patients on postoperative Day 2 and Day 3, respectively. In Group B, bile leakage noted in one patient after removal of the T-tube on Day 14 after operation ( P = 1.000). With a median follow-up time of 40 months for both groups, stone recurrence was noted in two patients in Group A and three patients in Group B ( P = 0.672). Primary closure of the CBD is safe and feasible in selected patients after laparoscopic choledochotomy. It results in shorter duration of hospital stay without the need for carrying/care of a T-tube in the postoperative period and similar stone recurrence as that of the conventional method.

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Primary Closure or T-Tube Drainage After Open or Laparoscopic Common Bile Duct Exploration?

Difficult Decisions in Surgery: An Evidence-Based Approach - Difficult Decisions in Hepatobiliary and Pancreatic Surgery ◽

10.1007/978-3-319-27365-5_18 ◽

2016 ◽

pp. 209-218

Author(s):

Ezra N. Teitelbaum ◽

Anthony D. Yang ◽

David M. Mahvi

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Primary Closure ◽

Common Bile Duct Exploration ◽

Tube Drainage ◽

T Tube

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Laparoscopic Choledochotomy in a Solitary Common Duct Stone: A Prospective Study

Minimally Invasive Surgery ◽

10.1155/2018/8080625 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

K. B. Deo ◽

S. Adhikary ◽

S. Khaniya ◽

V. C. Shakya ◽

C. S. Agrawal

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Common Bile Duct Stone ◽

Common Duct ◽

Bile Duct Stone ◽

Common Bile Duct Exploration ◽

T Tube ◽

Common Duct Stone ◽

Mean Size ◽

The Mean

Background. Laparoscopic common bile duct exploration has all the advantages of minimal access and is also the most cost effective compared to the other options. Objective. To study a profile on laparoscopic common bile duct exploration for a single common duct stone. Methods. A total of 30 consecutive patients with solitary common bile duct stone attending our hospital over a period of one year were enrolled in the study. Laparoscopic common bile duct exploration was done by transductal route in all the patients. Results. There were 18 females and 12 males with age ranging from 28 to 75 years. Jaundice was present in 12 (40%) patients. Twenty-four (80%) patients had raised alkaline phosphatase. The mean size of CBD on ultrasound was 11.55 mm. The mean size of calculus was 11.06 mm and was located in the distal CBD in 26 (86.7%) patients. The mean operative time was 158.4 ± 57.89 min. There were 8 (26.6%) conversions to open procedure. T-tube was used in 26 (86.7%) patients. The postoperative complications were hospital acquired chest infection in 3 (10%), surgical site infection in 3 (10%), acute coronary syndrome in one (3.3%), and bile leak after T-tube removal in one (3.3%) patient. Conclusions. Laparoscopic common bile duct exploration is an effective, safe management of common bile duct stone.

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