COMMON BILE DUCT EXPLORATION BY LAPROSCOPY: STENT DRAINAGE VERSUS T-TUBE DRAINAGE

*Dr. Yeshwant Ganpatrao Kale

ABSTRACT

Introduction: It is estimated that 10-15% of the patients operated because of gallstone disease have associated choledocholithiasis important potential source of complications like acute pancreatitis, obstructive jaundice, cholangistis. Laparoscopic common bile duct exploration is a cost effective, efficient and minimally invasive method of treating choledocholithiasis. After common bile duct exploration to avoid bile leakage from site of choledochotomy postoperative T-tube drainage is a traditional and standard procedure and the available drainage options include T-tube placement, common bile duct (CBD) primary closure or primary closure plus placement of biliary stent. Long-term retention of T-tube is sometimes associated with risk of infection, bile leakage and an uncomfortable accessory for the patient. Biliary stent is recommended as it can be spontaneously removed in a reasonable time, without interventions and complications. For this reason the use of spontaneously removed biliary stent evaluation was done after Laparoscopic common bile duct exploration. Material and Methods: A total of 36 patients with choledocholithiasis were included in the study. They were placed in 2 groups in group I as stent drainage group and Group 2 as T-tube drainage group. Both groups were operated for LCBDE. Out of 36 patients operated, 18 were in group I (stent drainage group) and 18 were in Group 2 (T-tube drainage group). Demographic data of all the patients was collected. Under all aseptic precautions surgeries were performed by the surgeon under general anaesthesia. A total of four trochars were used for the procedure. T-tube was removed between days 14 and 21 postoperatively after. The biliary stent drainage tube gets expelled by defecation without any special intervention. Results: 18 patients were placed in the stent drainage group and 18 patients in the T-tube drainage group. No perioperative and postoperative mortality was noted in our study. In stent drainage group there were 10 male (55.6%) and 8 (44.4%) females, while in T- tube drainage group (n= 18) males 9 (50%) and females9 (50%) were respectively. No statistically significant difference was observed in the male and female group. Statistically significant difference was observed in both the groups in term of operative findings and outcome (Table 3). Mean operation time in group I was 105± 24.2 while in group II was 124±34.5 (P value <0.005). Blood loss during operation in Stent drainage Group (n=18) was 25±3.5 while in T- tube drainage group (n= 18) was 36±4.2 (P value <0.005). Average abdominal drainage tube removal was 3 days in Stent drainage group and 4 days in T tube drainage group. Intestinal recovery time, postoperative bowel function recovery time was 2 days and 4 days in stent drainage group and T- tube drainage group respectively (P < 0.05). Total hospital stay was 7 days in Stent drainage group and 10 days in t tube drainage group. Conclusion: Primary closure of common bile duct with spontaneously removable biliary stent placement is safe and feasible after laparoscopic choledochotomy it has shown less surgical time, less bleeding and less intestinal complications.

Keywords: It is estimated that 10-15% of the patients treating choledocholithiasis.