Endoscopic nasobiliary tube drain (ENBTD) prior to laparoscopic cholecystectomy in acute± complicated cholecystitis: Influence on the rate of complications

Abstract

Background and aim: It is not known to what extent surgical outcome of laparoscopic cholecystectomy for acute or complicated cholecystitis differ from those for the chronic form, making it questionable whether urgent laparoscopic cholecystectomy is the best approach even in severe acute cases. Also, risk factors may predispose to bile duct injury or postoperative bile leakage associated with laparoscopic cholecystectomy (LC) including the presence of an accessory hepatic duct, the anomalous cystic duct confluence, and duct ofLuschka. A method to prevent the bile duct injury is a preoperative placement of an endoscopic nasobiliary tube drain (ENBTD). The aim of this review was to evaluate the efficacy ofENBTD assisted LC regarding prevention of intraoperative and postoperative bile duct injury or leakage. Methods: From April 2009 to June 2011, a total of 96 consecutive ENBTD assisted LCs for acute cholecystitis± complicated cholecystitis performed in our institutions were reviewed during this period. Results: Anomalous cystic duct confluence was detected in 3 cases and an accessory hepatic duct was detected in 2 cases. These anomalies were risk factors for bile duct injury in our series. However, there was no significant difference in the length of surgery or conversion rate to laparotomy, but significant decrease in the frequency of bile duct injury and leakage compared to the standard LC. Conclusion: Bile duct anomalies were seen in 6.72% ofLC cases. Placement of an ENBTD tube prior to LC in acute cholecystitis± empyema or gangerenous cholecystitis had successfully decreased the incidence of complications.