Laparoscopic primary choledochorrhaphy over endonasobiliary drainage tubes

Abstract

Laparoscopic choledochotomy over ENBD tubes proved to be technically feasible and safe. The ENBD tube decompresses the biliary tree and allows for cholangiography after surgery. Its removal does not need to wait for tract maturation, which allows an earlier removal of the tube and a shorter postoperative hospital stay. Laparoscopic choledochotomy over ENBD tubes is an effective alternative to the T-tube in laparoscopic choledochotomy.

Closure of the Common Duct -Endonasobiliary Drainage Tubes vs. T Tube: A Comparative Study

“…Many authors have successfully promoted primary closure of the common bile duct (CBD) without intraductal drainage with no significant serious morbidity [12][13][14][15][16][17][18][19][20][21] Others have used alternative methods but maintained the principle of biliary drainage by using retrograde transhepatic biliary drainage (RTBD) [22][23][24] or transcystic tube drainage(C tube) [22] We have previously reported the advantages of the use of endonasobiliary (ENBD) tubes as a means of postoperative CBD drainage [25] and this technique has also been subsequently applied to laparoscopic Choledocholithotomy [26]. In the present study we compared the results of intraductal drainage through ENBD tubes with the standard T tube, a comparison which has not been reported in literature.…”

Laparoscopic Primary Closure of Common Bile Duct Combined with Percutaneous Cholangiographic Drainage for Treating Choledocholithiasis

“…T HE T-TUBE IS WIDELY USED in both laparoscopic choledochotomy and open surgery to decompress the biliary tree and prevent extravasation of the bile leak. However, it is associated with a high complication rate, 17.4 per cent in our series 1,2 and 16.4 per cent as reported by Martin et al 3,4 When the common bile duct (CBD) exploration is performed, the choice lies between the T-tube drainage, primary duct closure with no drainage, 5 or primary duct closure with preoperative biliary stent insertion by endoscopic retrograde cholangio-pancreatography (ERCP). [6][7][8] T-tube drainage of the CBD is performed for the following reasons: 9 1) postoperative decompression of the CBD (if out-flow obstruction occurs), 2) postoperative visualization of the CBD and 3) availability of T-tube tract extraction of the CBD with a Burhenne steerable catheter.…”

“…Written permission was obtained from the copyright holder, the American Medical Association. 4 Demographic data including gender, age, symptoms, signs, associated diseases and procedures, stone sizes, stone numbers, and outcome variables including operation time, postoperative stay, conversions, complication rate, and stone clearance rate were analyzed statistically using x 2 and Fisher's exact test for categorical data and unpaired Student's t test for continuous data. A P value less than 0.05 was considered statistically significant.…”

Results of treatment of patients with gallstone disease and ductal calculi by single-stage laparoscopic cholecystectomy and bile duct exploration.

“…According to the ASGE, the risk of acute pancreatitis after ERCP is 1.3–6.7%, risk of infection is 0.6–5.0%, bleeding risk is 0.3–2.0%, and the perforation risk is 1–1.1% [24]. In our study we did not evaluate the long-term complications after ERCP and endoscopic sphincterotomy, which occur quite often and were described by other authors (stricture of papilla of Vater causing impeded flow of bile, narrowing or increase light mouth of the bile duct to the duodenum, bile reflux and recurrent cholangitis) [3, 14]. Duodenal biliary reflux may be the cause of recurrent choledocholithiasis.…”

“…Duodenal biliary reflux may be the cause of recurrent choledocholithiasis. Some authors have suggested an increased risk of carcinogenesis after endoscopic sphincterotomy and chronic cholangitis [14]. However, these reports have not been well documented.…”