A discussion on the management of T-tube following laparoscopic common bile duct exploration / 中国微创外科杂志

ABSTRACT

Objective To explore the management of Ttube following laparoscopic common bile duct exploration.Methods A total of 420 cases of extrahepatic with or without intrahepatic bile duct stones were given laparoscopic common bile duct exploration with T-tube drainage from July 1997 to October 2004 in this hospital.The common bile duct stones were identified and then a laparoscopic choledochotomy was carried out to remove the stones.After stone clearance,the choledochotomy wound was closed with primary duct suture or with T-tube drainage.Results The primary closure of the bile duct was performed in 27 cases((6.4%)) while the T-tube drainage was conducted in 393 cases(93.6%).The stones were completely removed during the operation in 236 cases(56.2%).Stone removal under choledochoscope was required in 184 cases(43.8%) after operation.The T-tubes were removed in 209 cases after a T-tube cholangiogram at 3~4 postoperative weeks showing no residual stones.Follow-up examinations for 3(months ~ 6) years(mean,47.5 months) in 420 cases revealed 3 cases of recurrence.Conclusions After laparoscopic common bile duct exploration,the T-tube should be removed at 3~4 postoperative weeks in the absence of residual stones on T-tube cholangiogram.However,if residual stones were found on T-tube cholangiogram,a choledochoscopy is needed for stone removal at 6 postoperative weeks after the tubes clamped for 2 weeks.