T‐tube‐free single‐incision laparoscopic common bile duct exploration plus cholecystectomy: a single centre experience

Abstract

Background The present study aimed to explore the indications and feasibility of T‐tube‐free trans‐umbilical single‐incision laparoscopic common bile duct exploration (SILCBDE) plus laparoscopic cholecystectomy (LC) for treating choledocholithiasis. Methods Patients hospitalized in the Second Affiliated Hospital (Shengjing Hospital) of China Medical University from January 2010 to January 2017 with the diagnosis of common bile duct stones and treated with T‐tube‐free trans‐umbilical single‐incision LC plus common bile duct exploration were retrospectively analysed. Results A total of 37 male/female choledocholithiasis patients (mean age 65 years, range 29–86) were treated with T‐tube‐free trans‐umbilical SILCBDE plus LC. No intraoperative complication or conversion to open surgery occurred in any of the cases. The mean operative time was 99.8 min (range 84–125) for endoscopic nasobiliary drainage group (n = 6), 113.8 min (range 70–150) for endoscopic retrogradebiliary drainage group (n = 2), 131.1 min (range 75–161) for pigtail J‐tube group (n = 24), 113.7 min (range 100–150) for primary closure group (n = 5). The mean post‐operative hospital stay length was 5.5 days (range 4–7) for endoscopic nasobiliary drainage group, 12.5 days (range 10–15) for endoscopic retrogradebiliary drainage group, 6.5 days (range 4–10) for J‐tube group, 5.8 days (range 4–9) for primary closure group. Pancreatitis, bile leakage and peritonitis were not presented in any of the group. After 17–101 months follow‐up, three patients presented recurrent common bile duct stones. Conclusion In selected cases, T‐tube‐free trans‐umbilical SILCBDE plus LC is feasible and safe for experienced surgeons, and can achieve similar therapeutic effects as common LC plus common bile duct exploration procedures.

Factors Influencing Suture Difficulty of T-tube Fixation and Closure in Laparoscopic Common Bile Duct Exploration

“…After CBD exploration, the next step is a latex rubber T-tube placement or primary suture of CBD. 3,4,[11][12][13][14] However, despite many efforts have been made to improve laparoscopic suture technique by the way of training and simulation, laparoscopic suture remains time-consuming and difficult to master, for it needs to suture and tie a knot with little maneuver range, in a small space, and within a limited visual field. 14 Moreover, laparoscopic T-tube anastomosis and fixation is more difficult and can better represent the difficulty of endoscopic suture than that of primary suture of CBD.…”

“…[5][6][7][8] After common bile duct (CBD) exploration, the next step is a latex rubber T-tube placement or primary suture of CBD. [9][10][11][12][13] However, despite many efforts have been made to improve laparoscopic suture technique by the way of training and simulation, laparoscopic suture remains timeconsuming and difficult to master during LCBDE, especially for beginners. 14 Difficult suturing can lead to prolonged suturing time and decreased suturing quality.…”