Use of Biliary Stent in Laparoscopic Common Bile Duct Exploration

Matthew J Lyon, MBBS, Seema Menon, MBBCh, MRCS, MCh, Abhiney Jain, MBBCh, Harish Kumar, MD, FRCS, FRCS. Darling Downs Health Serivce, University of Queensland.

INTRODUCTION
It is well supported in the literature that laparoscopic common bile duct exploration for choledocolithiasis has equal efficacy when compared to ERCP followed by laparoscopic cholecystectomy. Decompression after supraduodenal choledochotomy is common practice as it reduced the risk of bile leaks. We conducted a prospective non-randomized study to compare outcomes and length of stay in patients undergoing biliary stenting versus T-tube drainage following exploration of the common bile duct.

METHODS AND PROCEDURES
The study involved 126 patients with choledocolithiasis who underwent laparoscopic common bile duct exploration and decompression of the biliary system by either antegrade biliary stent or T-tube insertion. A 7 French Amsterdam straight biliary Diagmed™ stent (9-11cm) was placed in 82 patients (stent group). T-tube insertion was used for 36 patients (T-tube group). The length of hospital stay and complications for the selected patients were recorded. All trans-cystic common bile duct explorations were excluded from the study

RESULTS
The mean hospital stay for patients who underwent antegrade biliary stent or T-tube insertion after laparoscopic common bile duct exploration, were 1.04 and 3.41 days respectively. This a statistically significant result with a P value of less than 0.005.
Of the T –tube group two patients required laparoscopic washout due to bile leak after tube removal and two reported ongoing pain whilst the T-tube was in-situ. There were no complications or concerns reported for the biliary stent group.

CONCLUSION
Our results show that there is a significant reduction in length of hospital stay for patients that have antegrade biliary stent decompression of the common bile duct post laparoscopic choledochotomy when compared T-tube drainage. This implies antegrade billiary stent insertion is likely to reduce costs and increase overall patient satisfaction. We support the use of antegrade biliary stent insertion during laparoscopic exploration of the common bile duct when primary closure is not preferred.
 

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