The Feasibility Of SO-preserving And T-tube Free Laparoscopic Bile Duct Exploration

ObjectiveThe current management of choledocholithiasis remains a controversial topic. Popular options for treatment include preoperative endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (EST) followed by laparoscopic cholecystectomy (LC), or LC followed by laparoscopic common bile duct exploration (LCBDE) with placement of a T-tube. Some concerns suggest that sphincterotomy may have significant long-term complications as a result of an impaired sphincter of Oddi (SO), and T-tube placement is historically associated with many complications and discomfort. The purpose of this study was to demonstrate our simple and safe techniques of LCBDE with no T-tube and intact SO.MethodsBetween April 2006 and July 2009,44 selected patients with common bile duct (CBD) stones underwent LCBDE at our institute.ResultsOf 44 laparoscopic choledochotomies, primary choledochorrhaphies were performed over 10 (22.73%) and 10 (22.73%) preoperative installed endoscopic retrograde biliary drainage (ERBD) and endonasobiliary drainage (ENBD) tubes, respectively; and over 9 (20.45%) and 15 (34.09%) intraoperative C and pigtail J biliary drainage tubes, respectively. There was no conversion to open surgery and successful CBD clearance was achieved in 43 (97.73%).ConclusionLaparoscopic primary closure over internal and external biliary drainage tubes are safe and effective alternatives to T-tube placements. Major SO physiologic functions are well preserved to prevent recurrent bile duct stones and bile duct cancer.