Laparoscopic choledochotomy in management of choledocholithiasis.
OBJECTIVE
Laparoscopic choledochotomy on patients indicated for common bile duct exploration was carried out according to an algorithm for managing choledocholithiasis. This study describes retrospectively our method and evaluates a new cystic duct biliary decompression cannula (J-tube) as an alternative to the T-tube.


METHODS
Patients with confirmed choledocholithiasis (n=46) underwent laparoscopic choledochotomy. The T-tube was inserted in cases with suspected retained stones after common bile duct clearance, and the J-tube (950-mm long, 4 Fr) with a tapered and J-shaped segment at the distal end was inserted in other cases.


RESULTS
Only 1 case was converted to open surgery (success rate, 97.8%); the J-tube was inserted in 30 patients and the T-tube in 15. The median operation time, hospital stay, and the interval until removal of the tube were significantly shorter with J-tube than with T-tube cases. Bile leakage after surgery occurred in 4 J-tube and 2 T-tube cases with one residual stone in each case.


CONCLUSIONS
The transcystic decompression tube is easily and safely inserted with the J-kit. Among several strategies currently available for the management of choledocholithiasis, laparoscopic choledochotomy with the use of the J-tube is one of the safest and most feasible methods.
Kanamaru
Taichi
T
Division of Surgery, Kobe Rosai Hospital, Kobe, Japan. kanamaru@kobeh.rofuku.go.jp
Sakata
Kazuya
K
Nakamura
Yoichiro
Y
Yamamoto
Masahiro
M
Ueno
Nozomi
N
Takeyama
Yoshifumi
Y
D000465:Algorithms; D042883:Choledocholithiasis / Q000601:surgery*; D003135:Common Bile Duct / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods; D013505:Digestive System Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D012189:Retrospective Studies