Laparoscopic Common Bile Duct Exploration (lcbde) Using C- Tube, an Alternative Bile Drainage Method

Yoshihide Chino, PhD, Masaki Fujimura, PhD, Isao sato, MD, Seiji Masuda, MD, Makoto Mizutani, PhD, Tomotake Tabata, MD, Atsushi Okita, PhD, Minoru Iida, PhD. Daiichi-Towakai Hospital Endoscopic Surgery Center

INTRODUCTION
Recently, laparoscopic surgery has progressed rapidly as an alternative to open laparotomy in the treatment of common bile duct stones (CBDs). However, there are some problems associated with bile drainage after operations. These problems result from T-tube drainage, which is the traditional bile drainage method. Therefore, we developed a new drainage tube, C-tube (cystic duct tube), which contributes to shorter drainage periods and reduces perioperative complications. C-tube is a type of bile drainage tube, produced by Dr Fujimura in 1980. It has a 1cm metallic section to prevent canal obstruction and is fixed to the cystic duct with an elastic band. Bile leakage from the stump of the cystic duct is prevented by closing the duct with an elastic band as soon as C-tube is removed. The aim of our study is to show the safety and efficacy of LCBDE using C-tube.
METHOD
Between March 2004 and December 2009, 138 patients treated with LCBDE using C-tube were retrospectively reviewed. The median follow up was 12 months. Routine intra-operative and post-operative cholangiographies via C-tube were performed. The evaluated points were operation time, postoperative day of C-tube removal, the length of hospital stays, CBD stone clearance rate, morbidity and mortality.
RESULTS
There were 68 male and 70 female patients. Their mean age was 71±12 years. Previous operations had been performed in 17 patients. CBD stone clearance was performed with choledochotomy (98%) or transcystic exploration (2%). Mean operation time, postoperative C-tube removal time and hospital stays were 207 ±58min, 5.7±2.9 days, 10.8 ±8.0 days, respectively. The results of LCBDE without cholecystitis were significantly and statistically better than those of LCBDE with severe cholecystitis [operation time (min) : 234±62 vs. 181±45 (p<0.01), C-tube removal (days): 6.0±1.6 vs. 4.9±1.5 (p<0.05) , hospital stay (days) : 9.8±3.3 vs. 8.1±3.6 (p < 0.05)]. The CBD stone clearance rate was 98.5%. There was no major morbidity; bile leakage was 0%; common duct stricture 0%; bile originated peritonitis 0%; postoperative pancreatitis 0%). 4(2.9%) minor complications occurred, including 2 unexpected C-tube removals, 1 clip and band migration, and 1 technical error. The mortality rate was 0.7%. (1 acute myocardial infarction in postoperative day 15.)
CONCLUSION
Precise post-operative cholangiography via C-tube reduced missed and recurrent stone rates, and we experienced no bile related morbidity or mortality. Therefore, our evidence suggests that LCBDE using C-tube is a safe and feasible procedure for the laparoscopic treatment of CBD stones.