A comparative study using the transabdominal route versus the transoral route in establishing naso-biliary drainage in laparoscopic surgery

Abstract

Objective To compare using the transabdominal route versus the transoral route in establishing naso-biliary drainage in laparoscopic surgery. Methods The combined use of laparoscopy with choledochoscopy and duodenoscopy to establish naso-biliary drainage was carried out in 204 patients with gallbladder and common bile duct calculi. In 162 patients, the naso-biliary drainage was established transabdominally and in 42 patients it was established transorally. The success and the complication rates in the two groups were compared. Results Of 162 patients using the transabdominal route, 4 patients failed. There were 6 patients (3.7%) who had no output from the nasobiliary drain. There were 3 patients (1.8%) who had only intestinal juice outflow from the nasobiliary drain. Primary closure failed in 3 patients (1.8%), all resulting in bile leak. Pancreatitis occurred in 2 patients (1.2%) after the operation. There was 1 patient (0.6%) whose nasobiliary drain was wrongly ligated. Of 42 patients with nasobiliary drainage using the transoral route, 6 patients failed. There was 1 patient (2.4%) who had no output from the nasobiliary drain. There was 1 patient (2.4%) who had intestinal juice output from the nasobiliary drain. Primary closure failed in 1 patient (2.4%) with resultant bile leakage. Pancreatitis occurred in 4 patients (9.5%) after the operation. The success rate of establishing a nasobiliary drainage in the transabdominal group was significantly higher than that in the transoral group, but the complications were less. Conclusions Nasobiliary drainage established through the transabdominal route in laparoscopy surgery for patients with gallbladder and common bile duct calculi was technically easier and had a high success rate. It had less complications. Key words: Laparoscope; Choledochoscope; Choledocholithiasis; Nose bile duct