Transcystic biliary drainage versus nasobiliary drainage during primary closure of the laparoscopic choledochotomy / 中华外科杂志

Objective@#To compare the clinical efficacy of transcystic biliary drainage with nasobiliary drainage during primary closure following laparoscopic choledochotomy.@*Methods@#The clinical data of 106 patients with cholecystolithiasis and choledocholithiasis treated by laparoscopy at Department of General Surgery, Danyang People′s Hospital from May 2014 to June 2017 were analyzed prospectively. The patients were divided into 2 groups by means of random number method: the study group was treated with transcystic biliary drainage, and the control group adopted nasobiliary drainage. The operation time, postoperative drainage volume, postoperative hospital stay and postoperative complications were compared between the 2 groups.@*Results@#All patients in the two groups completed the operation successfully. Compared with nasobiliary drainage, the operation time of transcystic biliary drainage was shortened ((133.9±14.7) minutes vs. (143.3±21.7) minutes, t=-2.617, P<0.05). Postoperative hospital stay ((8.2±1.7) days vs. (7.7±2.5) days), the difference between the two groups was not statistically significant(P>0.05). The quantity of bile drainage was no significant difference in the two groups of patients. There were 1 case of duct obstruction and 2 cases of catheter slippage during transcystic biliary drainage, without causing bile leakage. During nasobiliary drainage, there were 3 cases of catheter obstruction, 1 case of catheter slippage, 2 cases of self extubation, 1 case of bile peritonitis caused by catheter blockage, transferred to laparotomy and T tube drainage. The patients were followed up for 1 month to 17 months, with an average of 8 months. B-ultrasound showed no bile duct stenosis and hepatic function was normal.@*Conclusions@#Transcystic biliary drainage could achieve the same biliary drainage as well as nasobiliary drainage during primary closure following laparoscopic choledochotomy. In addition, transcystic biliary drainage maintain the physiological function of bile duct, it is simple and minimally invasive under certain conditions.

Effect of External Biliary Drainage via Cystic Duct in Laparoscopic Choledochotomy with Primary Closure / 中国微创外科杂志

Objective To investigate the effectiveness and safety of the slender external biliary drainage tube (F5 ureter catheter) inserted into the common bile duct via the cystic duct in laparoscopic choledochotomy with primary closure.Methods Clinical data of 59 patients with cholecystolithiasis and choledocholithiasis treated in our hospital between Feburary 2013 and March 2016 were retrospectively analyzed.The patients were treated with laparoscopic common bile duct exploration followed by primary duct closure,and bile duct drainage with a slender catheter through cystic duct after closure of the choledochotomy.Results All the cases underwent surgery successfully.The postoperative output of bile drainage was 30-570 ml/d.There were no complications such as biliary leakage,cholangitis or biliary pancreatitis.The catheter was withdrawn in 6-8 d in 57 patients after the operation,and was withdrawn in 10-11 d in 2 patients after the operation.There was no discomfort after removing the catheter.Postoperative hospitalization time was (9.1 ± 2.0) d.All patients were followed up for 5 months to 3 years,with an average of 16 months.The B ultrasound examinations showed no residual bile duct stones and liver functions were normal.Conclusions External biliary drainage using a slender ureter catheter via the cystic duct is safe,effective and easy to perform.It may reduce postoperative potential complications,especially bile leakage.

Primary closure after laparoscopic choledochotomy with transcystic cholangiography and biliary drainage / 中华肝胆外科杂志

Objective To assess the clinical outcomes in patients who underwent laparoscopic primary closure of common bile duct (CBD) with or without transcystic cholangiography and transcystic biliary drainage.Methods From June 2013 to March 2016,we operated on 46 patients who underwent primary closure of common bile duct after laparoscopic choledochotomy (group A).The results were compared with 51 patients who underwent primary closure of common bile duct after laparoscopic choledochotomy together with transcystic biliary drainage (group B) during the same study period.Results There was a significant difference in the incidence of postoperative bile leakage between the two groups.The risk in group A was sig nificantly higher than group B (8.7％ vs 0％,P ＜0.05).The duration of operation in group A was significantly shorter than in group B [(125.3 ± 28.3) min vs (131.3 ± 20.5) min].There were no significant differences in the duration of hospital stay between the two groups [(7.3 ± 2.4) days vs (7.8 ± 1.9) days,P ＞ 0.05].All patients were followed up (range 3 months to 29 months,average 8.4 months).B-ultrasound examination showed no residual bile duct stones and the liver functions were normal.Conclusions Laparoscopic primary closure of common bile duct was possible after choledochotomy.Transcystic cholangiography and transcystic biliary drainage after primary closure of common bile duct were safer and more reli able.

Use of ureteral catheter for bile duct drainage in minimally invasive treatment of extrahepatic bile duct stones / 中华普通外科杂志

Objective To evaluate bile duct drainage with ureteral catheter through cystic duct in laparoscopic common bile duct exploration followed by primary duct closure (LCBDEPDC) and posto laparoscopic endoscopic stone extraction treatment of extrahepatic bile duct stones.Methods The clinical data of 116 cases of extrahepatic bile duct stones were retrospectively analyzed.Patients were divided into 2 groups: 57 patients with dilated common bile duct were in group A treated with laparoscopic common bile duct exploration followed by primary duct closure and via cystic duct ureteral catheter biliary drainage.While in group B (59 patients) with normal calibre of the common bile duct, the procedures was laparoscopic cholecystectomy + via cystic duct ureteral catheter biliary drainage and postoperative endoscopic stone extraction.Results Procedures were successful in both the two groups.There was no postoperative pancreatitis and biliary leakage complications.The catheter was withdrawn in 6-9 d in group A postoperative hospitalization time was (8.5 ± 2) d.The catheter was withdrawn in 2-8 d in group B after endoscopic stone extraction.Postoperative hospitalization time was (7.6 ± 3) d.No complications occurred in both two groups relating extubation.Conclusions Bile duct drainage using the ureteral catheter via cyst duct after LCBDEPDC and endoscopic stone extraction treatment of extrahepatic bile duct stones effectively prevent postoperative pancreatitis, biliary leakage and bile duct stricture.