Purpose: Laparoscopic common bile duct exploration (LCBDE) is feasible and is becoming popular. LCBDE has traditionally been accompanied by T-tube drainage which has a 4.7∼17.5% morbidity rate and increases hospital stay. Avoidance of T-tube drainage therefore should advantageously contribute to the ideal approach for LCBDE. The authors report a prospective evaluation of LCBDE with completion choledochoscopy and duct closure without T-tube drainage.
Methods: Between March 2001 and February 2004, 28 patients with common bile duct (CBD) stones underwent this approach for CBD stones. We adopted internal biliary stent (endobiliary stent) in 11 patients and performed primary closure for choledochotomy. Other 17 patient who had external drainage such as, endoscopic nasobiliary drain (ENBD), percutaneous transhepatic biliary drain (PTBD), were treated by LCBDE with primary closure.
Results: Open conversion, because of impacted large CBD stones, was 1 case (3.5%). The mean operative time of LCBDE was 139 mins, postoperative hospital stay was 8.8 days. Complication rate was 14.8% and no mortality. The rate of successful stone removal was 96.3%. Biliary stents were eliminated spontaneously via the gastrointestinal tract among 4 patients, and for 6 patients, the stents had to be removed endoscopically. The other 1 patient underwent laparotomy for stent removal.
Conclusion: LCBDE without T-tube was safe and feasible technique. Further study and assessment of internal biliary stent should be warranted.
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