Korean J Hepatobiliary Pancreat Surg.  2011 May;15(2):117-122. 10.14701/kjhbps.2011.15.2.117.

Comparison of Bile Drainage Methods after Laparoscopic CBD Exploration

• Kwon SU
• Choi IS
• Moon JI
• Ra YM
• Lee SE
• Choi WJ
• Yoon DS
• Min HS

• KMID: 1980950
• DOI: http://doi.org/10.14701/kjhbps.2011.15.2.117

Abstract

PURPOSE
T-tube is a major procedure that prevents complication by biliary decompression, but which is accompanied by complications. Therefore, several procedures such as ENBD, PTBD, and antegrade biliary stent have been attempted, but with controversies as to which procedure is superior. Also, there are no standard procedures after laparoscopic CBD exploration. We performed this study to ascertain the most appropriate biliary drainage procedure after laparoscopic CBD exploration.
METHODS
From March 2001 to December 2009, 121 patients who underwent Laparoscopic CBD exploration in Gunyang University were included for retrospective analysis. The patients were divided to 4 groups according to type of procedure, and we compared clinical parameters including age and gender, operation time, hospital stay, start of post-operative diet, and complications.
RESULTS
There was no difference in age, gender, mean operation time, postoperative diet between the 4 groups. Hospital stay in the Stent group was shorter than T-tube group. There were 10 (7%) complications that occurred. Two 2 occurred in the T-tube, 3 in PTBD, and 5 in the Antegrade stent group. There were more complications in Stent group but no significant statistical difference. In 5 cases with remnant CBD stone, a total of 4 (3 PTBD, 1 Stent) was performed by endoscopic CBD stone removal. One T-tube case was removed easily by choledochoscopy through the T-tube. Three migrated and the impacted stents were removed by additional endoscopy. Perioperative biliary leakage (1) and peritonitis (1) post t-tube removal were resolved by conservative treatment.
CONCLUSION
T-tube appears to be an appropriate method to patients who are suspected to have remnant CBD stones. Multiple procedures may be performed on a case by case basis such as performing PTBD first in a suspected cholangitis patient.

Keyword

Laparoscopic common bile duct exploration (LCBDE); Biliary drainage

MeSH Terms

Bile
Cholangitis
Decompression
Diet
Dioxolanes
Drainage
Endoscopy
Fluorocarbons
Humans
Length of Stay
Peritonitis
Retrospective Studies
Stents
Dioxolanes
Fluorocarbons

Figure

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  Fig. 1 Management algorithm of CBD stone.

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  Fig. 2 Management of drainage.

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  Fig. 3 Complications and their treatments.

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