Korean J Hepatobiliary Pancreat Surg.  2013 May;17(2):70-74. 10.14701/kjhbps.2013.17.2.70.

Ten-year experience on common bile duct exploration without T-tube insertion

• Lee W
• Kwon J

• KMID: 1429982
• DOI: http://doi.org/10.14701/kjhbps.2013.17.2.70

Abstract

BACKGROUNDS/AIMS
Common bile duct (CBD) exploration has been a procedure necessary to remove stones which are not removable by endoscopic sphincterotomy (EST). T-tube was installed mainly in the concern of bile leakage after procedure. But T-tube itself can only cause bile peritonitis and thus, prolonged discomfort and care after operation. In addition, in the era of laparoscopy, T-tube insertion adds much operation time and is technically difficult for installation during the procedure.
METHODS
Our case of open cholecystectomy and primary closure of CBD not leaving T-tube (n=28, group I) with reports dating from July 1998 to June 2007 is presented here to see whether primary closure without T-tube is safe as compared with T-tube inserted cases performed at the same center (n=15, group II). Operative cholangiography, CT scan, ultrasound and biochemical data were followed up for both groups and surveyed on operative complications as well to determine the outcomes.
RESULTS
Bile leakage in 1, recurrent stone in 2 and obstructive jaundice in 1 were all considered during the follow up period among 28 group I patients (n=6), when compared to T-tube inserted group II patients with 2 bile peritonitis, 1 residual stones and 1 pancreatitis (n=4), showing no meaningful differences (p=0.07).
CONCLUSIONS
CBD exploration and direct primary closure not leaving T-tube is an acceptable operational option as recently tried in many choledochotomies.

Keyword

T-tube; Choledochotomy

MeSH Terms

Bile
Cholangiography
Cholecystectomy
Common Bile Duct
Follow-Up Studies
Humans
Jaundice, Obstructive
Laparoscopy
Pancreatitis
Peritonitis
Sphincterotomy, Endoscopic

Reference

1. Zhu QD, Tao CL, Zhou MT, et al. Primary closure versus T-tube drainage after common bile duct exploration for choledocholithiasis. Langenbecks Arch Surg. 2011; 396:53–62. PMID: 20582601.

2. Ambreen M, Shaikh AR, Jamal A, et al. Primary closure versus T-tube drainage after open choledochotomy. Asian J Surg. 2009; 32:21–25. PMID: 19321398.

3. 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. 2008; 22:1595–1600. PMID: 18202889.

4. Wills VL, Gibson K, Karihaloot C, et al. Complications of biliary T-tubes after choledochotomy. ANZ J Surg. 2002; 72:177–180. PMID: 12071447.

5. Memon MA, Hassaballa H, Memon MI. Laparoscopic common bile duct exploration: the past, the present, and the future. Am J Surg. 2000; 179:309–315. PMID: 10875992.

6. Campbell-Lloyd AJ, Martin DJ, Martin IJ. Long-term outcomes after laparoscopic bile duct exploration: a 5-year follow up of 150 consecutive patients. ANZ J Surg. 2008; 78:492–494. PMID: 18522572.

7. Kanamaru T, Sakata K, Nakamura Y, et al. Laparoscopic choledochotomy in management of choledocholithiasis. Surg Laparosc Endosc Percutan Tech. 2007; 17:262–266. PMID: 17710045.

8. Martínez Cecilia D, Valentí Azcárate V, Qurashi K, et al. Advantages of laparoscopic stented choledochorrhaphy. Six years experience. Cir Esp. 2008; 84:78–82. PMID: 18682185.

9. Tang CN, Tai CK, Ha JP, et al. Antegrade biliary stenting versus T-tube drainage after laparoscopic choledochotomy--a comparative cohort study. Hepatogastroenterology. 2006; 53:330–334. PMID: 16795965.

10. Pérez G, Escalona A, Jarufe N, et al. Prospective randomized study of T-tube versus biliary stent for common bile duct decompression after open choledocotomy. World J Surg. 2005; 29:869–872. PMID: 15951939.

11. Wani MA, Chowdri NA, Naqash SH, et al. Primary closure of the common duct over endonasobiliary drainage tubes. World J Surg. 2005; 29:865–868. PMID: 15951929.

12. Wei Q, Hu HJ, Cai XY, et al. Biliary drainage after laparoscopic choledochotomy. World J Gastroenterol. 2004; 10:3175–3178. PMID: 15457567.

13. Wu JS, Soper NJ. Comparison of laparoscopic choledochotomy closure techniques. Surg Endosc. 2002; 16:1309–1313. PMID: 12235508.

14. Chen CC, Wu SD, Tian Y, et al. The fading role of T-tube in laparoscopic choledochotomy: primary choledochorrhaphy and over pigtail j and endonasobiliary drainage tubes. J Laparoendosc Adv Surg Tech A. 2010; 20:807–811. PMID: 21029026.

15. Naraynsingh V, Hariharan S, Ramdass MJ, et al. Open common bile duct exploration without T-tube insertion- two decade experience from a limited resource setting in the Caribbean. Indian J Surg. 2010; 72:185–188. PMID: 23133244.

16. Yin Z, Xu K, Sun J, et al. 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. 2013; 257:54–66. PMID: 23059495.

17. Cai H, Sun D, Sun Y, et al. Primary closure following laparoscopic common bile duct exploration combined with intraoperative cholangiography and choledochoscopy. World J Surg. 2012; 36:164–170. PMID: 22086256.

18. Savita KS, Bhartia VK. Laparoscopic CBD exploration. Indian J Surg. 2010; 72:395–399. PMID: 21966140.

19. Jameel M, Darmas B, Baker AL. Trend towards primary closure following laparoscopic exploration of the common bile duct. Ann R Coll Surg Engl. 2008; 90:29–35. PMID: 18201497.

20. Petelin JB. Laparoscopic common bile duct exploration. Surg Endosc. 2003; 17:1705–1715. PMID: 12958681.

21. Bandyopadhyay SK, Khanna S, Sen B, et al. Antegrade common bile duct (CBD) stenting after laparoscopic CBD exploration. J Minim Access Surg. 2007; 3:19–25. PMID: 20668614.

22. Ha JP, Tang CN, Siu WT, et al. Primary closure versus T-tube drainage after laparoscopic choledochotomy for common bile duct stones. Hepatogastroenterology. 2004; 51:1605–1608. PMID: 15532787.

23. Zhang LD, Bie P, Chen P, et al. Primary duct closure versus T-tube drainage following laparoscopic choledochotomy. Zhonghua Wai Ke Za Zhi. 2004; 42:520–523. PMID: 15196362.