Antegrade biliary stenting following surgical management of choledocholithiasis

Abstract

Background: T-tube drainage of the common bile duct following bile duct exploration has been standard surgical practice for most of the past century. An important drawback of surgical duct exploration and clearance over ERCP is the need for prolonged external biliary drainage via T-tubes and consequently added morbidity. As such interest grew in reassessing the need for T-tube drainage after CBD Exploration. This was especially augmented by increased popularity of laparoscopic CBD exploration at the time of cholecystectomy which could provide a solution to both problems in a single sitting. Methods: This is a prospective observational study. We present a series of 31 cases of open and laparoscopic bile duct exploration where we closed the choledochotomy over an endo-biliary stent which was subsequently removed endoscopically, thus obviating external biliary drainage. Results: In this study 31 patients undergoing CBD exploration at our institution between January 2017 and August 2018 were included after informed consent. These patients underwent primary closure of the CBD over an endobiliary stent without any T-tube. The mean age of the patients was 42 years (36-57 yrs). 19 of the patients were female and 12 were male. The average operating time was 135 min (120-150 min) for open surgery and 160 min (140-170 min) for laparoscopic cases. The average number of days of hospitalization was 5 in laparoscopic cases (4-14 days) and 7 in open surgical cases (6-12 days). The median follow up of patients was up to 18moths years (8 mths-2 yrs). There were no cases of bilioma/intra-abdominal collections requiring drainage. On long term follow up we could not find any clinical/laboratory evidence of development of biliary strictures. Conclusions: Endobiliary stenting after open or laparoscopic bile duct exploration is a safe and attractive option for biliary drainage with many advantages over T-tube and can be achieved with minimal additional skill and operative time.