Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 Oct;35(10):2283-9.
doi: 10.1007/s00268-011-1193-5.

Sphincter of Oddi-preserving and T-tube-free laparoscopic management of extrahepatic bile duct calculi

Chun-Chih Chen  1 , Shuo-Dong Wu, Yu Tian, Ernest Amos Siwo, Xin-Tao Zeng, Guang-Hui Zhang
Affiliations

Sphincter of Oddi-preserving and T-tube-free laparoscopic management of extrahepatic bile duct calculi

Chun-Chih Chen et al. World J Surg. 2011 Oct.

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.

PubMed Disclaimer

References

    1. World J Gastroenterol. 2005 Apr 21;11(15):2319-23 - PubMed
    1. J Gastrointest Surg. 2010 May;14(5):844-8 - PubMed
    1. Ann R Coll Surg Engl. 1985 Nov;67(6):370-1 - PubMed
    1. J Surg Res. 2009 Nov;157(1):e1-5 - PubMed
    1. Aust N Z J Surg. 1993 Jan;63(1):3-7 - PubMed