Yoshihide Chino, PhD, Masaki Fujimura, PhD, Isao Sato, MD, Hajime Yamasaki, PhD, Makoto Mizutani, PhD, Tomotake Tabata, MD, Shigeyoshi Shimaoka, MD, Tomoyuki Tagi, PhD, Minoru IIda, PhD. Daiichi Towakai Hospital Endoscopic Surgery Center
With the advent of laparoscopic procedures, laparoscopic common bile duct exploration (LCBDE) has played an important role in the treatment of CBDS. To avoid bile-originated complications, T tube is usually used during LCBDE in Western countries. However, in Japan C-tube is often used for bile drainage after hepato-biliaric surgery. The aim of the current study was to show the role of C-tube during LCBDE in our institute.
C-tube is a type of bile drainage tube, produced by Dr Fujimura in 1980. It 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. Between 2004 and 2014, 360 patients underwent LCBDE in our hospital. Postoperative bile drainage was carried out via C-tube in 92% patients. Routine intra-operative and post-operative cholangiographies via C-tube were performed. The points evaluated were: operation time, blood loss, post operative day of C-tube removal, length of hospital stays, CBD stone clearance rate, morbidity and mortality.
There were 183 male and 177 female patients. Their mean age was 70±13 years. Mean operation time, blood loss, postoperative C-tube removal time and hospital stays were 197 ±60min, 17±38ml, 4.9±2.5 days and 9.2 ±8.3days respectively. The CBD stone clearance rate was 98.0%. The missed stone rate was 2.5% and recurrent stone rate 3.0%. Missed stones were clearly distinguished from recurrent stones using post-operative cholangiographies. One patient who had missed stones was treated with GTN (Glyceryl trinitrate) infusion via C- tube. 0.8% bile leakage occurred. There was no CBD stricture or bile leak-originated peritonitis. C-tube caused problems in 1.3% of cases. However there was no major morbidity. The mortality rate was 0.5%.
Experience in our institute has shown C- tube to be a safe and feasible drainage tube to reduce LCBDE complications and shorten hospital stays.