The Fading Role of T-Tube in Laparoscopic Choledochotomy: Primary Choledochorrhaphy and Over Pigtail J and Endonasobiliary Drainage Tubes

Abstract

The traditional management of open/laparoscopic choledochotomy after common bile duct (CBD) exploration is accomplished by placement of a T-tube, a procedure historically associated with complications and discomfort. In this study, we share in humble our laparoscopic experience of the use of primary closure of CBD, primary closure over pigtail J, and endonasobiliary drainage (ENBD) tubes as easy and effective alternatives to T-tubes. From April 2006 to March 2009, 27 (16 women) patients with CBD stones underwent laparoscopic choledochotomy at our institute and were engaged in this study by means of T-tube-free approach after bile duct exploration: primary closure, pigtail J tube, and ENBD tube groups. On admission, routine laboratory and imaging workups were performed to confirm choledocholithiasis diagnosis. The mean operative time for primary closure, pigtail J tube, and ENBD tube groups were 95, 100, and 97.5 minutes, respectively. There was no conversion to open surgery nor was intraoperative complication experienced in all the groups. No major biliary complications such as bile leakage or bile peritonitis were seen; however, 1 patient from the pigtail J group experienced premature tube dislodgement and 1 patient from the ENBD tube group was found with a singular CBD retained stone. Laparoscopic primary closure of the CBD and over pigtail J and ENBD tubes are easy and effective alternatives to T-tube placements; these procedures are safe and with great feasibility, they offer faster recovery time for patients and early discharge with lower hospital charge.