Use of biliary stent in laparoscopic common bile duct exploration.

Abstract

INTRODUCTION:

It is well supported in the literature that laparoscopic common bile duct exploration (LCBDE) for choledocholithiasis has equal efficacy when compared to ERCP followed by laparoscopic cholecystectomy. Decompression after supra-duodenal choledochotomy is common practice as it reduced the risk of bile leaks. We conducted a prospective non-randomized study to compare outcomes and length of stay in patients undergoing biliary stent insertion versus T-tube drainage following LCBDE via choledochotomy.

METHODS AND PROCEDURES:

The study involved 116 patients with choledocholithiasis who underwent LCBDE and decompression of the biliary system by either ante-grade biliary stent or T-tube insertion. A 7 French straight/duodenal curve biliary Diagmed™ stent (9-11 cm) was placed in 82 patients (Biliary Stent Group). T-tube insertion was used for 34 patients (T-tube group). The length of hospital stay and complications for the selected patients were recorded. All trans-cystic common bile duct explorations were excluded from the study.

RESULTS:

The mean hospital stay for patients who underwent ante-grade biliary stent or T-tube insertion after LBCDE were 1 and 3.4 days, respectively. This is a statistically significant result with a p value of less than 0.001. Of the T-tube group, two patients required laparoscopic washout due to bile leaks, one had ongoing biliary stasis and one reported ongoing pain whilst the T-tube was in situ. A complication rate of 11.2%, this was a significant finding. There were no complications or concerns reported for the Biliary Stent Group.

CONCLUSION:

Our results show that there is a significant reduction in length of hospital stay and morbidity for patients that have ante-grade biliary stent decompression of the CBD post laparoscopic choledochotomy when compared T-tube drainage. This implies that ante-grade biliary stent insertion is likely to reduce costs and increase overall patient satisfaction. We support the use of ante-grade biliary stent insertion during LCBDE when primary closure is not preferred.

• Authors: Matthew Lyon, Seema Menon, Abhiney Jain, Harish Kumar
• Journal: Surgical endoscopy (Surg Endosc) Vol. 29 Issue 5 Pg. 1094-8 (May 2015) ISSN: 1432-2218 [Electronic] Germany
• PMID: 25249145 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Choledocholithiasis (surgery)
• Common Bile Duct (surgery)
• Decompression, Surgical (methods)
• Female
• Follow-Up Studies
• Humans
• Laparoscopy (methods)
• Male
• Middle Aged
• Prospective Studies
• Prosthesis Implantation (methods)
• Stents
• Young Adult