A modified transcystic biliary decompression after laparoscopic choledochotomy.

Abstract

Transcystic biliary decompression (TCBD) has been proposed as an alternative to T-tube placement after laparoscopic choledochotomy (LCD). This permits safe primary closure of the choledochotomy and eliminates the complication associated with T-tubes. The TCBD tube is usually secured by Roeder knots and transfixation, and removed 2 to 4 weeks after surgery. This appears to reduce the benefits of the minimal access approach. We present a new, secure TCBD method after LCD using the ureteral catheter and the Lapro-Clip (David and Geck, Danbury, Connecticut). As of October 2002, in 19 patients after LCD, a 5 Fr ureteral catheter were inserted into the common bile duct (CBD) via the cystic duct. When in place, the catheter was secured to the cystic duct by an absorbable 12 mm Lapro-Clip and the choledochotomy was then primarily closed. The average postoperative output of bile via the ureteral catheter was 256 mL/day (range, 20-600 mL/day). The median postoperative hospital stay was 5 days (range, 3-7 days). The ureteral catheter was removed within 3 to 7 days after surgery. None of the patients developed early complications such as bile leak, slippage of the Lapro-Clip, occlusion, or dislodgment of the ureteral catheter. A modified TCBD after LCD is safe, effective, and easy to employ. With this technique, the patients can be discharged within a week without any drainage tube. We propose this method as an option for patients with CBD stones.