title: Advantages of laparoscopic stented choledochorrhaphy over T-tube placement.
abstract: BACKGROUND
  Postoperative complications after laparoscopic choledochotomy are mainly related to the T tube. Both laparoscopic endobiliary stent placement with primary closure of the common bile duct (CBD) and primary closure of the CBD without drainage have been proposed as safe and effective alternatives to T tube placement.
  
  
  METHODS
  This was a retrospective analysis of data collected prospectively on 53 consecutive patients suffering from proven choledocholithiasis who underwent laparoscopic CBD exploration through a choledochotomy between January 1999 and January 2003. In the early period a T tube was placed at the end of the procedure (n = 32). Biliary stent placement and primary CBD closure was performed from June 2001 (n = 21).
  
  
  RESULTS
  There were no significant differences in epidemiological characteristics, preoperative factors or intraoperative findings between the groups. Seven patients developed complications, six in the T tube group and one in the stent group. Univariate analysis revealed a significantly lower morbidity rate and shorter postoperative hospital stay in the stent group.
  
  
  CONCLUSIONS
  Placement of a biliary endoprosthesis after laparoscopic choledochotomy achieves biliary decompression, and avoids the complications of a T tube, leading to a shorter postoperative hospital stay. The method is a safe and effective alternative method of CBD drainage after laparoscopic choledochotomy.
authors.affiliation: Upper Gastrointestinal and Laparoscopic Unit, Ealing and Charing Cross Hospitals, London, UK. a.isla@imperial.ac.uk
authors.forename: A M
authors.initials: AM
authors.lastname: Isla
authors.forename: J
authors.initials: J
authors.lastname: Griniatsos
authors.forename: E
authors.initials: E
authors.lastname: Karvounis
authors.forename: J D
authors.initials: JD
authors.lastname: Arbuckle
mesh_terms: D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D042883:Choledocholithiasis / Q000601:surgery*; D002768:Choledochostomy / Q000379:methods*; D004322:Drainage / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome