T tube free laparoscopic common bile duct exploration / 中国普通外科杂志

ABSTRACT

Objective To explore the feasibility and indications of T tube free laparoscopic common bile duct exploration (LCBDE). Methods The therapeutic results of LCBDE in 175 cases were reviewed retrospectively regarding the cure rate, complications, and postoperative hospital stay. Results LCBDE was performed successfully in 169 cases. Laparoscopic stone removal was failed in 6 out of the 175 cases. Two were converted to open exploration, the remaining 4 cases received intraoperative EST, the procedure failed in one case and it was converted to open surgery. T tube free LCBDE was performed successfully in 104 cases, in 36 out of the 104 cases laparoscopic transcystic common bile duct exploration was successful, the mean operation time was 140 minutes and the mean hospital stay after operation was 2 days; in other 68 cases laparoscopic choledochotomy with primary duct closure was performed, the mean operation time was 135 minutes and the mean hospital stay after operation was 3 days. T tubes were placed in 65 cases, the mean operation time for those patients was 150 minutes and the mean hospital stay after operation was 4 days, the mean T tube drainage time was 38 days. Retained stone was found in one out of the 65 cases, and was removed by EST. Bile leakage after removal of T tube developed in one case, and was cured by conservative therapy. No mortality nor complications such as bleeding or bile leakage occurred in remaining cases, asymptomatic hyperamylasia was found in 4 cases postoperatively. No stone recurrence or duct stricture were found at a mean follow-up of 13 months. Conclusions T tube free LCBDE as an alternative to the treatment of CBD stones is safe and feasible, with shorter hospitalization and avoiding the potential complications related to the T tube placement.