Yoshihide Chino, PhD, Masaki Fujimura, PhD, Isao Sato, PhD, Makoto Mizutani, PhD, Tomotake Tabata, MD, Tomoyuki Tagi, PhD, Naoki Matumoto, PhD, Shouichi Takayama, MD, Shigeyoshi Shimaoka, MD. First Towakai Hospital
INTRODUCTION: Laparoscopic common bile duct exploration (LCBDE) is a standard surgical procedure for the treatment of common bile duct stones(CBDs). However, there are some problems associated with CBD drainage after operations even if performing with the primary closure. Therefore, we developed a new drainage tube, C-tube, which contributes to shorter drainage periods and reduces perioperative complications.
METHOD: C-tube is a type of bile drainage tube which is fixed to the cystic duct with an elastic band. Closing the duct with an elastic band as soon as C-tube is removed prevents bile leakage from the stump of the cystic duct. The essential roles of this tube include: 1. Assisting suturing during operations, 2. Use during intra- and post- operative cholangiograpy, 3. Assisting post-operative endoscopic sphincterotomy when necessary. . Between March 2004 to December 2016, 519 patients treated with LCBDE using C- tube were retrospectively reviewed. The points evaluated were: operation time, blood loss, post-operative day of C-tube removal, length of hospital stays, CBD stone clearance rate, missed and recurrent stone rate, morbidity and mortality.
RESULTS: 550 patients were treated for CBDs. 519 patients were treated with LCBDE, 18 patients with laparotomy. 13 patients’ treatment was converted to laparotomy. Of all CBDs treatments, LCBDE was used in 90% of cases, including EST +LC. Mean operation times, postoperative C-tube removal days and hospital stays were 194±60min , 4.6±2.5 days, 8.1±7.2 days respectively. Mean blood loss was 27±45ml. The CBD clearance rate was 98%. Morbidities included pancreatitis (0.2%) and bile leakage (0.6%). The missed stone rate was 1.7 %. The recurrence rate was 4.1 %. The mortality rate was 0.4%. There were no major CBD strictures or life threatening bile leakage.
CONCLUSION: C-tube is a safe and feasible drainage tube for use during LCBDE, and plays an important role in reducing life-threatening complications in post LCBDE patients.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87153
Program Number: P760
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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