Antegrade biliary stenting following surgical management of choledocholithiasis
DOI:
https://doi.org/10.18203/2349-2902.isj20232980Keywords:
T Tube, Antegrade biliary stent, CBDE, Choledocholithiasis, Primary CBD closureAbstract
Background: T-tube drainage of the common bile duct following bile duct exploration has been standard surgical practice for most of the past century. An important drawback of surgical duct exploration and clearance over ERCP is the need for prolonged external biliary drainage via T-tubes and consequently added morbidity. As such interest grew in reassessing the need for T-tube drainage after CBD Exploration. This was especially augmented by increased popularity of laparoscopic CBD exploration at the time of cholecystectomy which could provide a solution to both problems in a single sitting.
Methods: This is a prospective observational study. We present a series of 31 cases of open and laparoscopic bile duct exploration where we closed the choledochotomy over an endo-biliary stent which was subsequently removed endoscopically, thus obviating external biliary drainage.
Results: In this study 31 patients undergoing CBD exploration at our institution between January 2017 and August 2018 were included after informed consent. These patients underwent primary closure of the CBD over an endobiliary stent without any T-tube. The mean age of the patients was 42 years (36-57 yrs). 19 of the patients were female and 12 were male. The average operating time was 135 min (120-150 min) for open surgery and 160 min (140-170 min) for laparoscopic cases. The average number of days of hospitalization was 5 in laparoscopic cases (4-14 days) and 7 in open surgical cases (6-12 days). The median follow up of patients was up to 18moths years (8 mths-2 yrs). There were no cases of bilioma/intra-abdominal collections requiring drainage. On long term follow up we could not find any clinical/laboratory evidence of development of biliary strictures.
Conclusions: Endobiliary stenting after open or laparoscopic bile duct exploration is a safe and attractive option for biliary drainage with many advantages over T-tube and can be achieved with minimal additional skill and operative time.
References
Williams JA, Treacy PJ, Sidey P, Worthley CS, Townsend NC, Russell EA. Primary duct closure versus T-tube drainage following exploration of the common bile duct. Aust Nz J Surg. 1994;64(12):823-6.
Halstead WS. Contributions to surgery of the bile passages, especially of the common bile duct. Bull Johns Hopkins. 1900;106:1-11.
Burhenne HJ. Nonoperative retained biliary stone extraction. Am J Roentgenol. 1972;117:388-90.
Paganini AM, Feliciotti F, Guerrieri M. Laparoscopic common bile duct exploration. J Laparoendosc Adv Surg Tech. 2001;11:391-400.
Wandling MW, Hungness ES, Pavey ES, Stulberg JJ. Nationwide Assessment of Trends in Choledocholithiasis Management in the United States From 1998 to 2013. Am J Roentgenol. 1985;2:87-91.
Rhodes M, Sussman L, Cohen L, Lewis MP. Randomized trial of laparoscopic exploration of common bile duct versus postoperative endoscopic retrograde cholangiography for common bile duct stones. Lancet. 1998;351:159-61.
Cuschieri A, Lezoche E, Morino M. EAES multicenter prospective randomized trial comparing two-stage vs single-stage management of patients with gallstone disease and ductal calculi. Surg Endosc. 1999;13:952-7.
Williams JAR, Treacy P, Sidey CS, Worthley NC. Primary duct closure versus t-tube drainage following exploration of the common bile duct. Lancet. 2003;512:32-9.
Gurusamy KS, Koti R, Davidson BR. T-tube drainage versus primary closure after laparoscopic common bile duct exploration. Cochrane Database Syst Rev. 2013; 6:CD005641.
Wills VL, Gibson K, Karihaloo C, Jorgensen JO. Complications of biliary T-tubes after choledochotomy. Surg Endosc. 2005;12:29-35.
