Spontaneously Removed Biliary Stent Drainage Versus T-tube Drainage After Laparoscopic Common Bile Duct Exploration

Objective : Gallstone disease is one of the most common problems in the gastroenterology and is associated with significant morbidity.It may present as stones in the gallbladder(cholecystolithiasis)or in the common bile duct(choledocholithiasis).If choledocholithiasis is not treated in time,it would progress to obstructive jaundice,acutecholangitis,pancreatitis thus increasing morbidity,and mortality.Several studies have shown the safety and feasibility of laparoscopic common bile duct exploration(LCBDE)as a minimally invasive treatment options for choledocholithiasis.Use of T-tube or biliary stent drainage tube placement after laparoscopic choledochotomy for common bile duct(CBD)stones is still under debate.This study tried to confirm the safety of spontaneously removable biliary stent in the distal CBD after LCBDE to allow choledochus primary closure.Methods:This study was conducted from September 2014 to September 2015 in the Second Affiliated Hospital of Dalian Medical University and Second Affiliated Hospital of Mudanjiang medical University.A total of 47 patients with choledocholithiasisunderwent LCBDE with primary closure and internal drainage using a spontaneously removable biliary stent drainage tube(stent group,N=22)or T-tube(T-tube group,N=25).Operative parameters and outcomes are compared.Surgical time,intraoperative blood loss,length of hospital stay,drainage tube removal time,postoperative intestinal function recovery,and cost of treatment were all significantly lower in the stent group as compared to that in the T-tube group(P<0.05 for all).Otherwise,Bile leakage between the two groups had no significant difference(P>0.05).Measure quality of life according to the quality of life index.There was no significant different in the quality of life index scores between the two groups 10 and 20 weeks after the operation(P>0.05).However,1,2,5weeks after the operation the quality of life index scores were all significantly lower in the stent group as compared to that in the T-tube group.The biliary stent drainage tube was excreted spontaneously 4 to 14 days after surgery with the exception of one case,where endoscopic removal of biliary tube was required due to failure of its spontaneous discharge.Conclusions:LCBDE with primary closure and use of spontaneously removable biliary stent drainage showed advantage over the use of traditional T-tube drainage in patients with choledocholithiasis.