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.

Our 12 year experience with Montgomery T-tube in the management of acute blunt laryngotracheal trauma patients / Nossa experiência de 12 anos com o tubo T de Montgomery no tratamento de pacientes com trauma laringotraqueal contuso agudo

Abstract Introduction The Montgomery T-tube is a device used as a combined tracheal stent and tracheostomy tube to prevent post-operative tracheal stenosis. Objectives The purpose of this retrospective study is to evaluate the outcome following Montgomery T-tube stenting performed in for neck and airway injury in patients with acute blunt laryngotracheal trauma over a period of 12 years. Methods Between 2005 and 2017, 19 patients with acute blunt laryngotracheal trauma underwent Montgomery T-tube stenting. All 19 laryngotracheal trauma patients had undergone a preoperative tracheostomy in the emergency department by an ENT surgeon. Montgomery T-tube stenting was done later through an external approach. The follow up period ranged from 2 to 10 years. The Montgomery T-tube was removed after a period ranging from 6 months to 1½ year. Results The majority of patients in the study were in the age group of 21-30 years. A preoperative tracheostomy was done in all 19 patients. All patients except 3 underwent successful decannulation, and experienced long-term satisfactory result. Conclusion Management of acute blunt laryngotracheal trauma is a challenging problem that demands a multidisciplinary approach. The ideal treatment option should be individualized according to the patient's condition and characteristics of injury. According to our study we suggest that cases of acute blunt laryngotracheal trauma patients should be managed following the protocol as mentioned in our study, and we strongly emphasize that Montgomery T-tube should be left for at least 1 complete year in the airway as it results in negligible chances of post-traumatic stenosis of airway later.

Resumo Introdução O tubo T de Montgomery é um dispositivo usado como stent traqueal combinado com tubo de traqueostomia para evitar estenose traqueal pós-operatória. Objetivo Avaliar o resultado do procedimento cirúrgico feito para lesões no pescoço e nas vias aéreas em pacientes com trauma laringotraqueal contuso agudo e o resultado da colocação do tubo T de Montgomery nesses pacientes por 12 anos. Método Entre 2005 e 2017, 19 pacientes com trauma laringotraqueal contuso agudo foram submetidos ao implante do tubo T de Montgomery. Todos os 19 pacientes com trauma laringotraqueal foram submetidos a uma traqueostomia pré-operatória no pronto-socorro por um cirurgião otorrinolaringologista. O implante do tubo T de Montgomery foi feito posteriormente através de uma abordagem externa. O período de seguimento variou de dois a 10 anos. O tubo T de Montgomery foi removido após um período que variou de seis meses a um ano e meio. Resultados A maioria dos pacientes do estudo estava na faixa de 21 a 30 anos. A traqueostomia pré-operatória foi feita em todos os 19 pacientes. Todos, exceto três, tiveram decanulação bem-sucedida e resultado satisfatório em longo prazo. Conclusão O tratamento do trauma laringotraqueal contuso agudo é um desafio que exige uma abordagem multidisciplinar. A opção de tratamento ideal deve ser individualizada de acordo com a condição do paciente e as características da lesão. De acordo com nosso estudo, sugerimos que os casos de pacientes com trauma laringotraqueal contuso agudo sejam tratados de acordo com o protocolo mencionado em nosso estudo e enfatizamos fortemente que o implante do tubo T de Montgomery deve ser mantido por pelo menos um ano completo nas vias aéreas, pois resulta em chances insignificantes de posterior estenose pós-traumática das vias aéreas.

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.

Experience with laparoscopic common bile duct exploration in failed endoscopic retrograde cholangiopancreatography cases at a tertiary care hospital

Background: Minimally invasive techniques for stone removal in common bile duct (CBD) are endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) or laparoscopic CBD exploration with LC (laparoscopic common bile duct exploration (LCBDE) and LC). Failed, multiple attempted or complications of ERCP leads to other surgical approaches where LCBDE is a preferable option by experts due to its added benefits.Methods:  We did LCBDE and LC in 40 cases of failed ERCP. Standard investigation protocol was followed in all cases and CBD were explored laparoscopically and stones were retrieved. Post retrieval choledochoscopy was done and sphincter of oddi was dilated by the dilators.Results: With careful selection of cases, stone calculi were retrieved successfully in 38 cases by laparoscopically and 2 cases by open method after conversion. Postoperative choledochoscopy were found normal. Bile leak seen in 3 cases, which were managed conservatively. Standard regime of postoperative care was taken followed by T-tube removal after cholangiogram on day 10-14. All patients survived the operation.Conclusion: We advocate that LCBDE is the most viable alternative for open surgery in failed ERCP cases for retrieval of CBD stones. This results in early recovery, better cosmetic scar, least complications with early resumption of routine life. Needs cautious patient selection and expertise in laparoscopic surgery.

Tratamiento de la coledocolitiasis mediante CPRE e instrumentación a través de un tubo en T / Treatment of choledocholithiasis by ERCP, and instrumentation through a T-tube

Resumen El tratamiento de la coledocolitiasis ha evolucionado de forma significativa desde que Robert Abbe realizó la primera coledocotomía y la exploración de las vías biliares en Nueva York, en 1889. La colangiopancreatografía retrógrada endoscópica (CPRE), que inicialmente fue un método diagnóstico, ahora solo tiene validez como método terapéutico. En la actualidad, los principales métodos diagnósticos son la colangioresonancia magnética (CRM) y la ultrasonografía endoscópica (USE). El tratamiento de la coledocolitiasis pasó de la técnica quirúrgica abierta -en la que, de forma rutinaria, se realizaba la coledocorrafia sobre un tubo de Kehr o tubo en T- a la endoscópica, mediante el uso de la CPRE, la esfinteroplastia y la instrumentación con balones y canastilla. Hoy en día se dispone de técnicas adicionales como la litotricia mecánica (LM) o extracorpórea, la dilatación con balón (DB) de gran tamaño y el Spyglass ® . La técnica laparoscópica se usa desde hace varios años, en diversas partes del mundo, para el tratamiento de la coledocolitiasis. Estudios recientes proponen incluso el cierre primario del colédoco o la coledocoduodenostomía, con lo cual no sería necesaria la utilización del tubo en T. Pero en muchos otros sitios, y por diversas razones, se continúa usando la exploración quirúrgica abierta y el tubo en T, que representa una importante opción en el tratamiento de algunos pacientes. Caso clínico: paciente masculino de 88 años, con coledocolitiasis recidivante, cálculo gigante de difícil manejo endoscópico y sepsis de origen biliar, que requirió drenaje quirúrgico abierto de urgencias. Se realizó una coledocotomía, y se dejó el tubo en T. Posteriormente, se efectuó un tratamiento exitoso conjunto, mediante instrumentación por el tubo en T, por parte de cirugía general, y CPRE, por gastroenterología.

Abstract The treatment of choledocholithiasis has evolved significantly since Robert Abbé performed the first bile duct exploration via choledochotomy in New York in 1889. Endoscopic retrograde cholangiopancreatography (ERCP), which was initially used for diagnosis, is now only valid as a therapeutic tool. Currently, the main diagnostic methods are magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound (EUS). The treatment of choledocholithiasis moved from the open surgery in which biliary stenting was routinely performed on a Kehr tube or T-tube, to the endoscopic technique using ERCP, sphincteroplasty and instrumentation with balloons and baskets. Additional techniques are now available such as mechanical or extra-corporeal lithotripsy, endoscopic papillary large balloon dilation and SpyGlass cholangioscopy. The laparoscopic technique has been used for several years in different parts of the world for the treatment of choledocholithiasis. Recent studies even propose performing the primary closure of the bile duct or choledochoduodenostomy, so that the T-tube is not necessary. However, in many other places, and for a variety of reasons, open exploratory surgery and the T-tube continue to be used, being an important option in the treatment of some patients. Case presentation: 88-year-old male patient with recurrent choledocholithiasis and a giant gallstone that was difficult to treat endoscopically, with sepsis of biliary origin, which required open surgical drainage at the emergency room. Choledocotomy was performed, and a T-tube was inserted at the site. Subsequently, a successful joint treatment was performed by the General Surgery Service and the Gastroenterology Service, using T-tube instrumentation and ERCP, respectively.

Spontaneous non-traumatic common bile duct perforation presented as an acute abdomen: a rare case report

The spontaneous perforation of the biliary tract (SPBT) is an extremely rare cause of peritonitis, which was first described by Freeland in 1882, to date only around 70 cases have been reported. Here we present a case of spontaneous perforation of the biliary tract, in a patient with choledocholithiasis. A 45 years old male presented to us with acute abdomen with raised amylase and lipase s/o pancreatitis, imaging showed acute on chronic pancreatitis with impacted distal lumen in situ common bile duct (CBD) calculi. Patient was planned for ERCP with CBD clearance after his acute episode subsides. Meanwhile patient developed rigidity, guarding and distension. His second CECT showed a breach in the lower lateral segment in the CBD with gross ascites. Patient was planned for laparotomy, abdominal lavage and T-tube drainage. Patient had a stormy postoperative course. Patient recovered well and was discharged with T-tube clamped and subhepatic drain in situ. Spontaneous perforation of the extrahepatic bile duct is a rare but important presentation of gall stones. Conservative surgery that is decompression of the biliary tree and repair of the leak site over T-tube is the mainstay of treatment in the acute presentation.

Primary closure of common bile duct versus T-tube placement after open choledocholithotomy

Background: Choledocholithiasis is primarily managed by endoscopic retrograde cholangiopancreatography (ERCP) but in certain situation particularly large and impacted common duct stone, the procedure may not succeed and this small group of patients require either open or laparoscopic common bile duct exploration followed by T-tube insertion. Usually T-Tube cholangiogram is performed on 10th postoperative day and tube is removed on 12-14th day. Alternatively, primary closure of duct after post exploratory choledochoscopy to ensure duct clearance with or without biliary stent can be done.Methods: This study was performed on 25 patients of failed endoscopic extraction, subjected to open choledocholithotomy. Group A (n=7) had T-tube insertion whereas group B (n=18) had primary closure of duct after choledochotomy.Results: 19 patients had calculus cholecystitis whereas 6 patients had prior cholecystectomy and later developed choledocholithiasis. 52% patients had impacted stone and 40% had large stone as a cause of ERCP failure. Postoperative pyrexia, cholangitis, septicemia, sub-hepatic bilious drainage and postoperative hospital stay was higher in T-tube group as compared to primary closure group.Conclusions: Primary closure over the biliary stent after cholecystectomy and/or choledocholithotomy has less morbidity as compared to T-tube insertion and hence should be preferred choice in choledocholithiasis, provided stone free duct is ensured peroperative using choledochoscopy.

Silicone stent insertion for treating tracheobronchomalacia in adults / 中国组织工程研究

BACKGROUND: Silicone tracheobronchial stent insertion can provide symptomatic relief through airway stabilization in patients with symptomatic tracheobronchomalacia. However, there are few studies on this method. OBJECTIVE: To evaluate the safety and efficacy of silicone stents in the treatment of tracheobronchomalacia. METHODS: Eight tracheobronchomalacia patients who underwent silicone stent implantation at Henan Provincial People’s Hospital between September 2015 and December 2018 were included in this study. According to the location and degree of airway softening, appropriate silicone stents were designed. Silicone stents were implanted in all eight patients, including hourglass stents in 2 cases, straight tube stents in 2 patients, Y-shaped stents in 3 patients, and T-shaped stents in 1 patient. All patients provided informed consent and this study was approved by the Medical Ethics Committee of Henan Provincial People's Hospital, China. Blood gas analysis was performed before and 30 days after surgery to measure blood oxygen level. Quality of life was assessed by card score. The position of stent, intraluminal endocrine, and granulation growth were dynamically monitored by bronchoscopy at 7, 30 and 60 days after surgery. RESULTS AND CONCLUSION: Silicone airway stents were placed successfully in seven patients. Dyspnea was relieved immediately. One patient had rupture of left main bronchial membrane during the procedure of insertion. The partial oxygen pressure and chi-square score of seven patients at 30 days after surgery were significantly higher than those before surgery (t=-8. 60, -20. 76, P < 0. 05). Tracheoscopy revealed that stent displacement occurred in 3 patients, difficulty in sputum expectoration and mild granulation tissue hyperplasia occurred in 3 patients, and improved after endoscopic treatment. The results suggest that silicone stent insertion in patients with tracheobronchomalacia can alleviate the symptoms of patients. Although the incidence of silicone stent displacement and sputum obstruction is high, silicone stent insertion is still an important treatment method.

Anaesthetic Management in Patient with Montgomery TTube in-Situ- A Case Report

Montgomery tube is a silicone tube which has greater flexibility and minimal tissue reaction. It can act as both tracheostomy tube and stent to keep the tracheal airway open after repair of tra-cheal stenosis.Here we report a successful management of a case of 45-year old male who had Montgomery tube in situ posted for Direct Laryngoscopy assessment to rule out subglottic steno-sis before decannulation trial.

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 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.

Laparoscopic end-to-end biliary reconstruction with T-tube for transected bile duct injury during laparoscopic cholecystectomy

PURPOSE: This report describes the laparoscopic end-to-end biliary reconstruction with T-tube for transected bile duct injury (BDI) during laparoscopic cholecystectomy. METHODS: We performed a retrospective descriptive analysis for all patients with a transected BDI at a single institution. We collected and analyzed data for injury site and type, reconstruction methods, conversion rate, previous intervention, and outcomes. RESULTS: Between January 2014 and December 2017, 2,901 patients underwent laparoscopic cholecystectomy at a single institution. Among them, 8 patients experienced a transected BDI during laparoscopic cholecystectomy, so the surgeon performed laparoscopic end-to-end biliary reconstruction with T-tube. Our patient series consisted of 6 women (75%) and 2 men (25%) with a mean age of 48.3 years (median, 49 years; range, 29–77 years). Two cases were converted to open surgery. The most common injured site was the common bile duct (5 of 8, 62.5%). The most common injury type, using Bismuth's classification system, was type I (3 of 8, 37.5%). The mean operating time was 136.8 minutes (median, 135.0 minutes; range, 0–180.0 minutes). The mean hospital stay was 7.0 days (median, 4.5 days, range: 3.0–21.0 days). The mean follow-up was 36.4 months (median, 34.0 months; range, 16.0–63.0 months). We observed one postoperative complication during the follow-up period. The patient had an anastomosis site leakage and was cured after reoperation. CONCLUSION: Laparoscopic end-to-end biliary reconstruction with T-tube for transected BDI during laparoscopic cholecystectomy seems to be safe and feasible in selected patients. However, long-term follow-up to identify complications from bile duct stricture remains important.

Laryngo Tracheal Stenosis : Management And Its Outcomes

Introduction: Laryngotracheal stenosis (LTS) implies a partial or complete narrowing of the larynx and/or trachea. Surgical management of it is technically challenging due to complex anatomy and delicate nature of airway structures. Ourstudy aims to study clinical profile, management, and surgical outcome of LTS. Materials and Methods: All patients with LTS treated between 2015 and 2018 were included in in our study.They underwent endoscopic assessment followed by definitive management which included endoscopic and external surgical techniques. The success of treatment was defined by decannulation Subjective assessment of voice quality.Results: A total of 30 patients with benign LTS were treated. Prolonged intubation was the single largest cause (56%). subglottic stenosis formed the largest group (74%) followed by Tracheal stenosis (14%).patiens were devided in four group depending upon surgical procedure they underwent:GROUP–I,endoscopic laser excision and dilatation(12cases),GROUP–II laryngo tracheoplasty and t–tube insertion(10 cases),GRUP–III tracheal stent insertion(3 cases),GROUPIV–Rection and anstomosis.Rate of decannalation following this surgical procedure in GROUP–I,GROUP–II,GROUP–III and GROUP–IV were 58%,60%,33% and80%.A total of 19 patients (63%) have been successfully decannulated. Conclusions: The use of appropriate size, low pressure cuffed tubes, and early tracheostomy will help in preventing LTS. The precise assessment of laryngotracheal complex is most useful in planning of management. Choice of treatment depends on location, severity, and length of stenosis, as well as on patient comorbidities an dhistory of previous interventions. Goal of our treatment modality is to achieve a patent airway and acceptable voice quality.

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.

In vivo porcine training model of laparoscopic common bile duct repair with T-tube insertion under the situation of iatrogenic common bile duct injury

PURPOSE: We introduce a training porcine model for laparoscopic common bile duct (CBD) repair with T-tube insertion. The model could be the feasible training tool for a surgeon learning hepatobiliary surgery. METHODS: Totally laparoscopic CBD repair with T-tube insertion was performed on 9 pigs by 9 trainees naïve in hepatobiliary surgery. Similar to the situation of iatrogenic injury, CBD was transected by laparoscopic scissors at the middle part about 1 cm in length, and the transected CBD was repaired through end-to-end anastomosis with T-tube insertion. A secureness of anastomosis was confirmed by saline leakage test and all animals were sacrificed after the surgery. RESULTS: All novice surgeons completed operations successfully without complications. Total mean operative time was 85 ± 1.7 minutes and the mean time spent performing the CBD repair with T-tube insertion was 71 ± 3 minutes. There was no bile leakage after primary anastomosis in all animals. CONCLUSION: This porcine training model for laparoscopic CBD repair with T-tube insertion could be a feasible and effective training tool for surgeons with little experience in laparoscopic hepatobiliary surgery.

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.

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.

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.