A Comparative Study of Common Bile Duct Drainage by T-tube and Choledochoduodenostomy in Cases of Common Bile Duct Stones

To study and compare the cases of ‘T’-tube drainage and Choledochoduodenostomy done for Common Bile Duct stones. Methods : A prospective study was conducted from October 2019 – September 2021 (24 months including followup period) in patients diagnosed to have Choledocholithiasis in MGM Medical College and Hospital, Kishanganj, Total 50 patients were Included in this study. Those patients in whom CBD stones detected incidentally on investigation like Ultrasonography upper abdomen done for chronic calculus cholecystitis or detected during surgery for cholecystectomy ie, asymptomatic stones were also included in this study. Results : In the cases of our study, most of the patients (62%) didn’t has sludge. Choledochoduodenostomy was more frequently performed when sludge was present (P=0.043), whereas ‘T’-tube drainage was performed when sludge was absent. only 19 cases (38%) had sludge. And also it was present more commonly with larger diameter CBD (P value =0.016). Conclusion : In this study, both the surgical procedures did not produce any mortality. Some patients developed complications. This could be because much of the study population was elderly and most of the complications were noted in patient with acute cholangitis. In both the group, wound infection was noted to be most common complication. All of the patients treated conservatively successfully.

Comparison between primary suture and T tube drainage in 124 cases of laparoscopic choledocholithotomy / 中国医师进修杂志

Objective:To investigate the clinical difference between primary suture and T tube drainage in laparoscopic choledocholithotomy.Methods:The clinical data of 124 patients treated by laparoscopic choledocholithotomy in Suzhou Municipal Hospital from December 2018 to February 2020 were retrospectively studied. The patients were divided into the primary suture group (71 cases) and the T tube drainage group (53 cases) according to the different surgical methods, and the differences in the relevant treatment indicators were compared between the two groups.Results:There were no statistically significant differences between the two groups in gender, hypertension, diabetes mellitus, preoperative aspartate aminotransferase, preoperative alanine aminotransferase, preoperative total bilirubin, preoperative common bile duct diameter, postoperative length of stay, total cost of hospitalization, postoperative exhaust time, or postoperative biliary leakage, et al. Compared with the T tube drainage group, the primary suture group had more single choledocholithiasis before operation (33 cases vs. 15 cases), shorter operation time: (100.14 ± 38.90) h vs. (140.45 ± 54.17) h, less intraoperative bleeding: (35.70 ± 30.17) ml vs. (49.53 ± 34.58) ml, and later extraction time of Winslow hole drainage tube after operation: (7.15 ± 2.61) d vs. (5.45 ± 3.35) d, and the differences were statistically significant ( P<0.05). Conclusions:Under the condition of strictly controlling the indications of primary suture and being operated by general surgeons who can skillfully operate laparoscope and choledochoscope, laparoscopic choledocholithotomy for primary suture has better curative effect than T tube drainage, and has higher clinical application value.

Internal drainage tube versus T tube in laparoscopic common bile duct exploration / 中华肝胆外科杂志

Objective:To study the effect of internal drainage tube and T tube in laparoscopic common bile duct exploration.Methods:The data of 103 patients who underwent laparoscopic common bile duct exploration for the treatment of choledocholithiasis from January 2016 to April 2021 in Dongguan Kanghua Hospital were analyzed, including 50 males and 53 females, aged (50.3±17.2) years old, the age range was 15 to 90 years old. A total of 103 patients were randomly divided into T tube group ( n=60), who received laparoscopic cholecystectomy + choledocholithotomy and stone removal+ T tube drainage, and self-dropping stent group ( n=43), who received laparoscopic cholecystectomy + choledocholithotomy and stone removal + placed with self-dropping stent. The operation time, intraoperative blood loss, postoperative drainage, postoperative hospital stay and incidence of postoperative complications were compared between the two groups. Results:The operation time of self-dropping stent group was (107.2±26.1) min, intraoperative blood loss 10(5, 10) ml, and postoperative hospital stay (6.5±3.5) d, which were better than those of T tube group (143.5±52.7) min, 10(10, 20) ml, (8.8±3.8) d, the differences were statistically significant (both P<0.05). There were no significant difference in postoperative drainage volume and postoperative complications between the two groups (both P>0.05). Conclusion:The internal drainage tube in laparoscopic common bile duct exploration is a safe and reliable surgical method for the treatment of choledocholithiasis, which can significantly shorten the hospitalization time of patients.

Efficacy of laparoscopic choledochotomy and T tube drainage for the patients of extrahepatic bile duct stones / 国际外科学杂志

Objective To observe the effect and quality of life score of laparoscopic choledochotomy and T tube drainage for the patients of extrahepatic bile duct stones.Methods A total of 80 patients with calculus of extrahepatic bile duct in Shandong Provincial Third Hospital from February 2016 to April 2017 were retrospectively analyzed,including 41 males and 39 females,among which,40 patients were treated with laparoscopic choledocholithotomy and T tube drainage(the study group),and the other 40 cases were operated on laparotomy (the control group) by hierarchical randomization grouping.After operation,the time of operation,the amount of bleeding during the operation,the time of postoperative exhaust,the time of postoperative hospitalization and the difference of adverse reactions were observed in the two groups.Follow-up at the end of 1 st and 3th month,quality of life score was compared between the two groups.The measurement data with normal distribution were expressed as mean ± standard deviation (Mean ± SD),comparison between groups were performed using t test.The count data were expressed as rate(％),comparison between groups were performed using chi-square test.Results Comparison of data between the study group and the control group:operation time respectively were (97.23 ± 10.21) min,(117.52 ± 10.01) min,the amount of bleeding respectively were(87.73 ± 10.54) ml,(185.13 ± 11.56) ml,postoperative exhaust time respectively were (17.57± 2.96) h,(38.44 ± 3.06) h and the postoperative hospitalization time were (7.75 ± 1.21) d,(12.03 ± 3.85) d.The data of each group in the study group were lower than those in the control group,and the difference was statistically significant(P ＜ 0.05).The quality of life scores of the 1 months and 3 months after treatment in the study group were (45.82 ± 3.22) scores and (47.29 ± 3.09) scores,the control group were (32.56 ± 3.29) scores and (36.19 ± 3.06) scores.The study group was significantly superior to the control group,and the difference was statistically significant(P ＜ 0.05).The complications of the patients in the study group were not statistically significant between the control group and the control group(P ＞ 0.05).Conclusions Compared with open surgery,laparoscopic choledocholithotomy with T tube drainage has significant clinical effect in the treatment of extrahepatic bile duct stones.It can improve the quality of life and safety,and it is suitable for clinical application.

Clinical research of laparoscopic common bile duct exploration with primary suture and T tube drainage in the management of choledocholithiasis / 国际外科学杂志

Objective@#To investigate the short-term clinical efficacy of laparoscopic common bile duct exploration(LCBDE) with primary suture or T tube drainage in the management of choledocholithiasis.@*Methods@#The retrospective cohort study was conducted from January 2014 to December 2018 with the clinical data of patients with choledocholithiasis being analyzed. A total of 863 patients were enrolled in this study. There were 431 males and 432 females. The median age was 60 (range 11 to 94). These patients had received LCBDE with primary suture (n=287) and T tube drainage (n=576) in the Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University. Observation indicators: (1)Preoperative blood biochemistry, including blood serum levels of total bilirubin, direct bilirubin, ALT, AST, GGT. (2) Intraoperative conditions, including operation time, blood loss, diameter of common bile duct, number of common bile duct stone.(3)Short-term postoperative conditions, including postoperative hospital stay, postoperative complications. Measurement data with non-normal distribution were described as M (P25, P75), and comparison between groups was done using Mann-Whitney U test. Comparison of count data between groups were analyzed using the chi-square test. Univariate analysis and subsequent multivariable logistic regression were used to investigated the factors affecting the selection of surgical methods.@*Results@#(1) Blood serum levels of total bilirubin and direct bilirubin in the T tube drainage group were 17.0(12.2, 36.0) μmol/L, 7.6(4.9, 19.0) μmol/L, which were significantly higher than those of the primary suture group[15.7(11.8, 29.7) μmol/L, 6.7(4.4, 16.5) μmol/L)](Z=-2.023, -2.468, P<0.05). Preoperative blood serum levels of ALT, AST and GGT in the T tube drainage group were 56.7 (26.6, 128.8) U/L, 38.0(24.3, 75.8) U/L and 179.7(50.8, 394.4) U/L, the primary suture group were[68.2(24.8, 165.3) U/L, 35.5(22.8, 96.9) U/L and 235.2(74.9, 459.1) U/L], with no difference between the two groups (Z=-0.985, -0.437, -1.740, P>0.05). (2)The operation time of the primary suture group was 85(70, 100) min, which was significantly shorter than that of the T tube drainage group[97(75, 120) min](Z=-5.532, P<0.05). The diameter of common bile duct in the primary suture and T tube drainage group were 1.0(0.8, 1.2) cm and 1.0(0.8, 1.2) cm, respectively. Significant difference was observed between the two groups(Z=-2.071, P<0.05). The intraoperative blood loss in the primary suture and T tube drainage group were 20(10, 50) ml and 20(20, 50) ml, with no difference between the two groups (Z=-0.477, P>0.05). 61.32%(176/287) and 67.36%(388/576) of patients in the primary suture group and T tube drainage group were found with multiple stones in the common bile duct, with no difference between the two groups (χ2=3.083, P>0.05). (3)The primary suture group showed shorter postoperative hospital stay compared with the T tube drainage group[4(3, 5) d vs 6(5, 6) d, Z=-12.057, P<0.05]. The primary suture group showed more patients with bile leakage (2.09%) compared with that of the T tube drainage group (0.35%). Multivariable logistic regression showed that the number of common bile duct stone, diameter of common bile duct, time period of surgery, surgery group were significant factors affecting the selection of surgical methods(OR=1.687, 2.423, 0.587, 4.632, 95%CI: 1.152-2.470, 1.519-3.865, 0.511-0.675, 3.698-5.802, P<0.05).@*Conclusions@#Although different surgeons showed different opinions with the method of primary suture, laparoscopic common duct exploration with primary suture is safe and reliable in the management of choledocholithiasis with shorter operation time and faster postoperative recovery. T tube drainage is not absolutely necessary in the management of choledocholithiasis. Patients with multiple common bile duct stone or large diameter of common bile duct are likely to receive T tube drainage.

Clinical research of laparoscopic common bile duct exploration with primary suture and T tube drainage in the management of choledocholithiasis / 国际外科学杂志

Objective To investigate the short-term clinical efficacy of laparoscopic common bile duct exploration(LCBDE) with primary suture or T tube drainage in the management of choledocholithiasis.Methods The retrospective cohort study was conducted from January 2014 to December 2018 with the clinical data of patients with choledocholithiasis being analyzed.A total of 863 patients were enrolled in this study.There were 431 males and 432 females.The median age was 60 (range 11 to 94).These patients had received LCBDE with primary suture (n =287) and T tube drainage (n =576) in the Department of General Surgery,the First Affiliated Hospital of Nanjing Medical University.Observation indicators:(1) Preoperative blood biochemistry,including blood serum levels of total bilirubin,direct bilirubin,ALT,AST,GGT.(2) Intraoperative conditions,including operation time,blood loss,diameter of common bile duct,number of common bile duct stone.(3) Short-term postoperativeconditions,including postoperative hospital stay,postoperative complications.Measurement data with non-normal distribution were described as M (P25,P75),and comparison between groups was done using Mann-Whitney U test.Comparison of count data between groups were analyzed using the chi-square test.Univariate analysis and subsequent multivariable logistic regression were used to investigated the factors affecting the selection of surgical methods.Results (1) Blood serum levels of total bilirubin and direct bilirubin in the T tube drainage group were 17.0(12.2,36.0) μmol/L,7.6 (4.9,19.0) μmol/L,which were significantly higher than those of the primary suture group[15.7 (11.8,29.7) μmol/L,6.7 (4.4,16.5) μmol/L)] (Z =-2.023,-2.468,P ＜ 0.05).Preoperative blood serum levels of ALT,AST and GGT in the T tube drainage group were 56.7 (26.6,128.8) U/L,38.0 (24.3,75.8) U/L and 179.7 (50.8,394.4) U/L,the primary suture group were [68.2 (24.8,165.3) U/L,35.5(22.8,96.9) U/L and 235.2(74.9,459.1) U/L],with no difference between the two groups (Z =-0.985,-0.437,-1.740,P ＞ 0.05).(2) The operation time of the primary suture group was 85 (70,100) min,which was significantly shorter than that of the T tube drainage group [97 (75,120) min] (Z =-5.532,P ＜ 0.05).The diameter of common bile duct in the primary suture and T tube drainage group were 1.0(0.8,1.2) cm and 1.0 (0.8,1.2) cm,respectively.Significant difference was observed between the two groups(Z =-2.071,P ＜ 0.05).The intraoperative blood loss in the primary suture and T tube drainage group were 20(10,50) ml and 20(20,50) ml,with no difference between the two groups (Z =-0.477,P ＞0.05).61.32％ (176/287) and 67.36％ (388/576) of patients in the primary suture group and T tube drainage group were found with multiple stones in the common bile duct,with no difference between the two groups (x2 =3.083,P ＞ 0.05).(3)The primary suture group showed shorter postoperative hospital stay compared with the T tube drainage group [4 (3,5) d vs 6 (5,6) d,Z =-12.057,P ＜ 0.05].The primary suture group showed more patients with bile leakage (2.09％) compared with that of the T tube drainage group (0.35％).Multivariable logistic regression showed that the number of common bile duct stone,diameter of common bile duct,time period of surgery,surgery group were significant factors affecting the selection of surgical methods (OR =1.687,2.423,0.587,4.632,95％CI:1.152-2.470,1.519-3.865,0.511-0.675,3.698-5.802,P＜0.05).Conclusions Although different surgeons showed different opinions with the method of primary suture,laparoscopic common duct exploration with primary suture is safe and reliable in the management of choledocholithiasis with shorter operation time and faster postoperative recovery.T tube drainage is not absolutely necessary in the management of choledocholithiasis.Patients with multiple common bile duct stone or large diameter of common bile duct are likely to receive T tube drainage.

Efficacy of laparoscopic common bile duct exploration and primary duct closure in the treatment of choledocholithiasis / 国际外科学杂志

Objective To investigate the clinical efficacy and safety of laparoscopic common bile duct exploration and primary common bile duct closure in the treatment of extrahepatic bile duct calculi.Methods The clinical data of 215 patients undergoing laparoscopic common bile duct exploration from October 2010 to December 2016 in Wuxi Xishan People' s Hospital were retrospectively analyzed.According to the different surgical methods,patients were divided into two groups:laparoscopic common bile duct exploration and primary common bile duct closure group(primary duct closure group,n =122) and laparoscopic common bile duct exploration group(T-tube drainage group,n =93).Operation time,intraoperative blood loss,recovery time of gastrointestinal tract,liver function in postoperative 1 week and hospitalization expenses,postoperative hospital stay(t test) and postoperative complications (x2 test) were compared.All patients were follow-up by clinic and telephone for 6 months.Measurement data were represented as ((x) ± s),and t test was used between the two groups,while count data using x2 or Fisher test.Results The postoperative hospital stay in primary duct closure group and T-tube drainage group was(8.5 ± 1.9) days and (12.5 ±2.4) days respectively,the difference between the two groups was statistically significant(P ＜ 0.05).The hospitalization costs in primary duct closure group and T-tube drainage group were (1 200 ± 300) yuan and (1 400 ± 500) yuan,the difference was statistically significant (P ＜ 0.05).Postoperative analgesia in primary duct closure group and T-tube drainage group was 11 cases and 32 cases statistically,and the difference was statistically significant (P ＜ 0.01).There were no significant difference in the operation time,intraoperative blood loss,recovery time of gastrointestinal tract,liver function 1 week after operation and postoperative bile leakage between the two groups (all P ＞ 0.05).There was no long-term complications in both groups after 6 follow-up months.Conclusion Under favorable operation technology and strictly grasp the surgical indications,laparoscopic common bile duct exploration and primary common bile duct closure has good clinical application value,and can embody minimally invasive and enhance recovery.

Comparison Of T-Tube Drainage Versus Primary Closure Of Common Bile Duct After Choledochotomy In Case Of Choledocholithiasis

Choledocholithiasis is the common problem that necessitates surgical intervention. It is managed either by endoscopic sphincterotomy or surgical exploration i.e. choledochotomy. The traditional surgical management of CBD stones consists of a supra-duodenal choledocotomy and insertion of a Ttube. The role of T–tube has been challenged since Thornton and Halsted described primary duct closure after CBD exploration. This study was carried out with an aim to evaluate the feasibility and safety of primary closure as compared to T-tube drainage in choledocholithiasis cases requiring CBD exploration. 70 patients in the age group of 18-60 years presenting with common bile duct stone were included after obtaining informed and written consent with exclusion of patients with malignant conditions and CBD dilation >2.5 cm. Patients fulfilling the inclusion criteria were randomly allocated into two groups of 35 patients each: Group I (Primary repair group) and Group II (T-tube repair group).In Group I duration of hospital stay ranged from 8 to 20 days (mean 12.03±2.60 days) whereas in Group II this range was 18 to 29 days (mean 22.74±3.41 days. Statistically, the difference between two groups was significant (p<0.001).The primary closure was a feasible, safe and relatively better technique as compared to T-tube drainage. It had fewer complications and a smooth and shorter duration of hospital stay which have both economic as well as psychological implications.

Primary closure versus T-tube drainage following laparoscopic common bile duct exploration in acute cholangitis cases / 国际外科学杂志

Objective To compare the clinical efficacy of primary closure versus T-tube drainage after laparoscopic common bile duct exploration in acute cholangitis cases.Methods The clinical data of 100 patients with acute cholangitis undergoing laparoscopic common bile duct exploration from January 2012 to December 2014 were reviewed.54patients received primary closure of the common bile duct and 46 patients were subjected to T-tube drainage after choledochotomy.Results One hundred patients underwent the surgery successfully.Compared with the T-tube group,the operation time(96.72 min vs 123.00 min,P =0.001),intraoperative blood loss(27.13 ml vs 38.48 ml,P =0.009),postoperative gastrointestinal function recovery time(1.57 d vs 2.33 d,P=0.003) and postoperative hospital stay(6.19 d vs 9.20 d,P=0.000) were significantly less in the primary closure group.There were no statistical differences in the incidence of postoperative drainage (309.22 ml vs 212.46 ml,P =0.070),drainage time (3.96 d vs 4.02 d,P =0.875),incidence of bile leakage(9.3％ vs 0,P =0.060) and postoperative bleeding rate(5.1％ vs 2.2％,P =0.622) between these two groups.Conclusion Laparoscopic common bile duct exploration with primary closure of the common bile duct is an effective and safe procedure in acute cholangitis cases compared with T-tube drainage.

Preliminary application of 3D laparoscopy in the biliary tract surgery / 中国内镜杂志

Objective This paper preliminarily research the clinical effect of 3D laparoscopy in the biliary tract surgery.Methods Thirty-eight patients clinical data of cholelithiasis who accepted laparoscopic cholecystectomy and laparoscopic choledocholithotomy T-tube drainage from January 2015 to June 2016 were retrospectively analyzed,which sixteen patients underwent three-dimensional laparoscopic surgery while twenty-two patients underwent two-dimensional laparoscopic surgery. The operation time, intraoperative blood loss, postoperative drainage,time of drainage, postoperative hospital stay, hospital costs and the incidence of complications were observed in two groups.Results There was a statistical significant (P 0.05) in postoperative drainage, time of drainage, postoperative hospital stay, hospital costs and the incidence of complications between the two groups. One patient of 2D group suffered residual stones and recovered by choledochoscopy through T tube sinus after two months, while no one suffered residual stones in 3D group. There was no recurrence of stones in both groups during the follow-up period which varied from two months to eighteen months.Conclusions 3D laparoscopy enables biliary tract surgery was more accurate and minimally invasive, it has a widely applicable prospect.

"Double ""T"" tube drainage in hepatic echinococcosis which ruptured into the common bile duct" / 中华肝胆外科杂志

Objective To investigate the double T tube drainage method in the treatment of hepatic echinococcosis which ruptured into the common bile duct.Methods A retrospective study was conducted on 86 patients who were treated surgically for hepatic echinococcosis which had ruptured into the common bile duct at the First Affiliated Hospital of Xinjiang Medical University from June 2012 to December 2014.The average postoperative hospitalization,postoperative complications (residual cavity bile leakage and residual cavity effusion,residual cavity infection) and biliary complications of biliary tract infection were analyzed.Results Significant differences were found on the postoperative residual cavity complications in group A:(2,7.1％) when compared with Group B:(9,15.5 ％),and also on the postoperative hospitalization between the double T tube drainage group [group A:(7.1 ± 1.3) d] and the traditional T type tube decompression group [B group:(8.2 ± 1.5) d] (P ＜ 0.05).Conclusions The doubleT tube drainage in the treatment of hepatic echinococcosis which had ruptured into the common bile duct was simple,safe and effective.This treatment could completely cure residual cavity bile leakage,and it had the advantage of avoiding occurrence of common bile duct related complications caused by the traditional suture method for bile leakage.

Laparoscopic self-releasing J tube drainage combined with primary suturing of common bile duct in the treatment of extrahepatic cholangiolithiasis / 中华肝胆外科杂志

Objective To study the feasibility and efficacy of treatment of extrahepatic cholangiolithiasis using laparoscopic self-releasing J-tube drainage combined with primary suturing of common bile duct.Methods The clinical data of 172 patients with extrahepatic cholangiolithiasis who underwent operations from March 2013 to January 2015 were retrospectively studied.The patients were divided into two groups:the J-tube drainage group (n =82) and the T-tube drainage group (n =90).Surgical duration,intraoperative bleeding,postoperative hospital stay,treatment cycles,hospital costs,incidences of postoperative bile leakage and residual extrahepatic cholangiolithiasis were compared between the two groups.Results The length of postoperative hospital stay in the J-tube drainage group was (4.9 ± 1.2) days and in the T-tube drainage group was (8.0 ± 2.0) days.The treatment cycles in the J-tube drainage group were (4.9 ± 1.2) days while in the T-tube drainage group were (24.1 ± 3.2) days.The hospital costs in the J-tube drainage group were (12 817.1 ±3 167.1) yuan and the costs in the T-tube drainage group were (15 012.5 ±2 354.8) yuan.There were significant differences in hospital stay,treatment cycles and hospital costs between the two groups (all P ＜ 0.05).The surgical duration in the J-tube drainage group was (108.2 ± 10.2) minutes and the duration in the T-tube drainage group was (110.1 ± 13.1) minutes.The amount of intraoperative bleeding in the J-tube drainage group was (35.0 ± 20.0) ml and the amount in the T-tube drainage group was (42.0 ±30.0) ml.There were no significant differences in intraoperative bleeding and surgical duration between the two groups (all P ＞ 0.05).No significant differences were observed in the incidences of post-operative bile leakage and in residual extrahepatic cholangiolithiasis between the two groups (P ＞ 0.05).Conclusions Self-releasing J-tube drainage combined with laparoscopic primary suturing of common bile duct was safe and efficacious.It was minimally invasive in treating patients with extrahepatic cholangiolithiasis.

Application of Nasobiliary Duct Instead of T-tube in Laparoscopic Common Bile Duct Exploration and Primary Suture / 中国微创外科杂志

Objective To explore the application value of nasobiliary duct instead of T-tube in primary suture after laparoscopic common bile duct exploration (LCBDE). Methods A total of 58 cases of choledocholithiasis without acutecholangitis were divided into experimental and control group according to the odevity of the last number of admission number .Patients in odd number belonged to experimental group , while the even number patients belonged to control group .The experimental group received endoscopic nasobiliary drainage ( ENBD ) combined with LCBDE and primary suture;the control group underwent LCBDE combined with T-tube drainage .The intraoperative and postoperative data were compared between the two groups . Results All surgeries were completed successfully under laparoscope .The experimental group had much shorter hospital stay than that of the control group [(7.5 ±2.1) d vs.(10.3 ±3.2) d,t=-3.965,P=0.000].No significant differences were found in the operative time , incidence of bile leakage and postoperative incision pain between the two groups (P>0.05).All the cases were followed up for 6-12 months (average, 9 months) and no patients were hospitalized due to complications related to the billiary surgery .MRCP showed no complications such as biliary stricture and residual stones 6 months after operation . Conclusions Nasobiliary duct can substitute for T-tube in LCBDE .It ensures the safety of the primary suture and reduces T-tube related complications .

Application of Laparoscope with Choledochoscope in Treatment of Cholangiolithiasis / 昆明医科大学学报

Objective To discuss the way of treatment of bile duct stone with laparoscope and choledochoscope. Methods Forty six patients with bile duct stones admitted in our hospital from July 2001. to July 2008 were selected in this study. The 46 cases were divided into two groups:the control and observation group.The control group included 22 patients who were performed cholecystectomy and choledochotomy with T tube drainage. The obeservation group included 24 patients who were performed laparoscope and choledochoscope operation.We used the Mann-Whites statistics and compared the incidence of complications, the amount of bleeding and hospitalized days in patients between two groups. When P<0.05, the difference between the two groups was considered statistically significant. Results The incidence of complications after operation, amount of bleeding and hospitalized days in patients had no statistically significant difference between two groups. The time of operation in observation group was longer than control group. The bile stones eradication rate in observation group was higher than control gourp. and the bile stones recurring rate in observation group was lower than control gourp. Conclusion It is better to treat the bile duct stones by using laparoscope with choledochoscope than the way of traditional cholecystectomy and choledochotomy with T tube drainage, the former has advantages such as higher bile duct stones edarication rate, lower recurring rate, safer and more reliable operation and fewer complications.

A comparative study on upfront common bile duct suturing and T-tube drainage after exploration of common bile duct stones / 中华普通外科杂志

Objective To evaluate upfront common bile duct suturing against T-tube drainage after exploration in the treatment of common bile duct stone.Methods 253 cases of extrahepatic bile duct stones treated at our department from 2008 June to 2012 January were randomly divided into primary suture group and T tube drainage group,by t test or analysis of variance independent sample comparison.Results All operations were successful.Postoperative bile leakage was observed in 2 patients in group A and 4 in group B respectively(P ＞ 0.05),there was no reoperations in the two groups.In group B retrograde biliary tract infection developed in one and was cured by biliary tract flush combined with antibiotics administration.The abdominal drainage was bile tainted fluid about 5-10 ml a day in bile leakage cases in both groups and healed itself in 3-4 days without fever,jaundice symptoms.There was no other severe complications such as pancreatitis.The postoperative biliary complication rate (P =0.802),operative time (P =0.137),intraoperative blood loss (P =0.069) and liver function recovery(ALT P =0.087,AST P =0.752,TBIL P =0.459,DBIL P =0.217,ALP P =0.576,GGT P =0.362) was not significantly different between the two groups.In group A postoperative flatus passing (P =0.037),postoperative fluid volume (P =0.008),postoperative hospital stay(P =0.015) were better than that in T-tube drainage group.At 3 to 12 months follow-up,no patients were found to have residual stones and biliary stricture in group A and group B.Conclusions With the definite indication and proficient surgical technology,primary suture of common bile duct after exploration is a safe and effective way after treatment of choledocholithiasis.

Primary suture of common bile duct after exploration / 国际外科学杂志

Objective To study the feasibility, indications and clinical value of primary suture after the common bile duet exploration(CBDE).Methods One hundred and fimr cases of choledocholithiasis were chosen for primary suture by 5-Oviger after CBDE. Post-operative complications and the length of hospital stay were compared with those with T-tube drainage. Results Compared with T-tube drainage group, the complication rate was reduced and the length of hospital stay in primary suture group was shortened. And also the mortality and operation time were decreased significantly. Conclusion The primary suture after CBDE in selected oases is safe and reliable.

Influence of the smooth of bile duct examined by choledochoscope during the common bile duct exploration on patients / 中国实用护理杂志

Objective To discuss the influence of the smooth of bile duct examined by choledochoscope during the coInnlon bile duct exploration on the biliary tract theology.Methods Forty patients who were to undergo common bile duct exploration were divided into the control group and the test group with 20 eases in each group.The smooth of the distal common bile duct was examined by choledochoscope in the test group while by routine method in the control group.The T tube drainage volume for 24 h,the pressure,flow volume and resistance of common bile duct and amylase content of drainage were monitored in the two groups within 72 h.Results The T tube drainage volume of the second day increased.the pressure and the resistance of the common bile duct decreased,the flow volunle and amylase content of drainage reduced in the control group,which had statistical difference from those of the test group(P＜0.05).Condusion Avoidance of damaging examination of the distal common bile duct,monitoring of the pressure;flow volume and resistance of the common bile duct within 72 h after operation contributed to the confirmation of the time for clamping T tube early.

Comparison of Clinical Characteristics between Primary Closure of Common Bile Duct and T-tube Drainage after Choledochotomy / 한국간담췌외과학회지

BACKGROUND/AIMS: In the management of choledocholithiasis, T-tube drainage was the most common treatment modality after common bile duct (CBD) exploration. However, the T-tube drainage has several problems and risk of complications such as abdominal discomfort, long duration of drainage, or bile leakage. We evaluated the effectiveness of primary closure of CBD after choledochotomy and the possibility of substitution for T-tube drainage. METHODS: Seventy six patients with choledocholithiasis who had undergone CBD exploration were enrolled in this study from January 1999 to March 2001. 20 patients among them had undergone primary closure of CBD with preoperative endoscopic nasobiliary drainage (ENBD) or percutaneous transhepatic biliary drainage (PTBD) in situ after exploration (primary closure group), 56 patients had undergone T-tube drainage (T-tube group). We compared the clinical characteristics and outcome between two groups. RESULTS: There was no difference in postoperative complication (19.6% vs. 20%), the mean amount of biliary drainage (326 ml/day vs. 320 ml/day) and the duration of hospitalization (11.6 day vs. 9.2 days) between the both groups. The duration of biliary drainage was significantly longer in the T-tube group (45.3 days) than in the primary closure group (9.2 days; p<0.01). The rate of remnant stone was higher in the T-tube group (32.1%) than the primary closure group (20%), there was not statistically significant. CONCLUSION: The primary closure of CBD with the preoperative biliary drainage was relatively safe and resulted in no difference of clinical outcome. Furthermore, this method induced going back early to normal life. These result suggest that the primary closure of CBD may be a feasible technique after choledochotomy when the patients are selected by specialized indications.

The interventional treatment for biliary recurrent obstruction after palliative T tube drainage in patients with obstruction due to cholangiocarcinoma / 介入放射学杂志

Objective To explore the interventional method to treat biliary recurrent jaundice after T tube drainage in patients with malignant obstructive jaundice due to cholangiocarcinoma. Methods 7 bili ary metallic stents were placed in 7 patients with recurrent jaundice after T tube drainage in cholangiocarcinoma cases. Results Stent placement was once successful in all 7 cases with successful rate of 100%. For all cases, TBIL,ALT,GTP and AKP values 7 days postoperatively were significantly lower than that of preoperation together with subsidence of jaundice satisfactorily for 100% after the treatment.Conclusions Percutaneous placement of biliary metallic stents was effective economic, minimal invasive and safe for palliation of biliary recurrent jaundice after T tube drainage in cholangiocarcinoma induced obstructive jaundice.

Modified laparoscopic exploration of common bile duct:A report of 42 cases / 中国微创外科杂志

Objective To investigate the technique and instrument improvement of laparoscopic choledocholithotomy with T-tube drainage. Methods A total of 42 cases of gall stones complicated with common bile duct stones entered the study. During the operation, we exposed the common bile duct before the removal of the gall bladder, opened the common bile duct by a self-made bile duct scalpel, removed the stones by open instruments laparoscopically, and performed choledochofiberscopic examinations and T-tube drainages. Results All the 42 operations were successfully accomplished without the conversion to open surgery. The operation time (exclusive of that of LC) was 80～180 min (mean, 96 min). All the patients got out of bed and received liquids within 24 hours after the surgery. The postoperative hospital stay was 5～9 days (mean, 6 days). The T-tube was removed 3 weeks after the operation in the absence of residual stones or stenosis of bile duct under T-tube choledochography. Follow-up for 6～48 months (mean, 23 months) in 38 cases found no recurrence of stones or biliary tract symptoms. Conclusions The modified laparoscopic choledocholithotomy with T-tube drainage, which shortens the operation time, is an effective and safe method for the treatment of common bile duct stones.