Sphincter of Oddi-preserving and T-tube-free Laparoscopic Management of Extrahepatic Bile Duct Calculi

Overview

Journal World J Surg

Publisher Wiley

Specialty General Surgery

Date 2011 Jul 23

PMID 21779932

Citations 8

Authors

Chun-Chih Chen

Shuo-Dong Wu

Yu Tian

Ernest Amos Siwo

Xin-Tao Zeng

Guang-Hui Zhang

Affiliations

Soon will be listed here.

Abstract

Background: The current management of choledocholithiasis remains a controversial topic. Popular options for treatment include preoperative endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (EST) followed by laparoscopic cholecystectomy (LC), or LC and laparoscopic common bile duct exploration (LCBDE) with T-tube decompression. Some concerns suggest that sphincterotomy has significant long-term complications as a result of sphincter of Oddi (SO) dysfunction, and T-tube decompression is historically associated with many complications and discomfort. The purpose of this study was to demonstrate our simple, safe techniques of LCBDE without a T-tube and with an intact SO.

Methods: Between April 2006 and July 2009, a total of 44 selected patients with common bile duct (CBD) stones underwent laparoscopic exploration at our institution. Of 44 laparoscopic choledochotomies, primary choledochorrhaphy was performed on patients with preoperatively installed endoscopic retrograde biliary drainage (ERBD) tubes (n = 10, 22.73%) or endonasobiliary drainage (ENBD) tubes (n = 10, 22.73%) and on patients with intraoperative biliary drainage C-tubes (n = 9, 20.45%) or pigtail J biliary drainage tubes (n = 15, 34.09%).

Results: The mean operating time for the ENBD, ERBD, J-tube, and C-tube groups were 97.8, 96.2, 102.1, and 98.7 min, respectively. There were no conversions to open surgery, and no intraoperative complications were experienced in any group. CBD clearance was achieved in 43 patients (97.73%). The mean lengths of follow-up for the ENBD, ERBD, J-tube, and C-tube groups were 27.0, 26.7, 23.8, and 30.4 months, respectively; and none of the patients developed major biliary complications including recurrent stones.

Conclusions: Laparoscopic primary closure with internal and external biliary drainage tubes is safe and an effective alternative to T-tube placement, especially for younger patient groups able to endure bile duct exploration. Sphincter of Oddi function is well preserved to prevent recurrent bile duct stones and bile duct cancer. Procedures are safe with great feasibility.

Citing Articles

Clinical efficacy of laparoscopic cholecystectomy plus cholangioscopy for the treatment of cholecystolithiasis combined with choledocholithiasis.

Liu C, Chen Z, Yu Z, Liu H, Pan J, Qiu S World J Gastrointest Surg. 2024; 16(7):2080-2087.

PMID: 39087102 PMC: 11287684. DOI: 10.4240/wjgs.v16.i7.2080.

Effect of endoscopic sphincterotomy and endoscopic papillary balloon dilation endoscopic retrograde cholangiopancreatographies on the sphincter of Oddi.

Fu K, Yang Y, Chen H, Zhang G, Wang Y, Yin Z World J Gastrointest Surg. 2024; 16(6):1726-1733.

PMID: 38983341 PMC: 11230004. DOI: 10.4240/wjgs.v16.i6.1726.

Invited Commentary to "Safety and Feasibility of Primary Closure Following Laparoscopic Common Bile Duct Exploration for Treatment of Choledocholithiasis" by Lunjian Xiang et al.

Podda M, Ielpo B World J Surg. 2023; 47(4):1031-1032.

PMID: 36703000 DOI: 10.1007/s00268-023-06917-6.

Primary closure combined with C-tube drainage through cystic duct after laparoscopic common bile duct exploration is safe and feasible for patients.

Sui X, Sui Z, Gu X, Ding M, Miao G Front Surg. 2022; 9:972490.

PMID: 36386513 PMC: 9640775. DOI: 10.3389/fsurg.2022.972490.

Biliary Microbiota in Choledocholithiasis and Correlation With Duodenal Microbiota.

Han J, Wu S, Fan Y, Tian Y, Kong J Front Cell Infect Microbiol. 2021; 11:625589.

PMID: 33996618 PMC: 8116743. DOI: 10.3389/fcimb.2021.625589.

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