ENBD tube placement prior to laparoscopic cholecystectomy may reduce the rate of complications in cases with predictably complicating biliary anomalies.
BACKGROUND
The risk factors predisposing to bile duct injury or postoperative bile leakage associated with laparoscopic cholecystectomy (LC) include the presence of an accessory hepatic duct, the anomalous cystic duct confluence, and duct of Luschka. One method to prevent bile duct injury is preoperative placement of an endoscopic nasobiliary drainage tube (ENBD assisted LC). The aims of this investigation are first, to report the incidence of bile duct anomalies according to the classification system proposed by Wakayama Medical University and second, to evaluate the efficacy of ENBD assisted LC with regard to prevention of intraoperative bile duct injury and postoperative bile duct injury or leakage.


METHODS
A total of 1,835 consecutive LCs performed at our institution during a recent 10-year period were reviewed.


RESULTS
Anomalous cystic duct confluence was detected in 11 cases and an accessory hepatic duct was detected in 37 cases. These anomalies were risk factors for bile duct injury in our series. However, there was no significant difference in the length of surgery, conversion rate to laparotomy, or frequency of bile duct injury or leakage between the standard LC group and ENBD assisted LC group.


CONCLUSIONS
A bile duct anomaly was seen in 2.6% of LC cases. Placement of an ENBD tube prior to LC in predictably complicating bile duct anomalies may have successfully decreased the incidence of complications.
Noji
Takehiro
T
Department of Surgery, Teine-Keijinkai Hospital, 1-12 Maeda, Teine-ku, Sapporo, Hokkaido, 060-8585, Japan. t-noji@tkeijinkai.gr.jp
Nakamura
Fumitaka
F
Nakamura
Toru
T
Kato
Kentaro
K
Suzuki
On
O
Ambo
Yoshiyasu
Y
Kishida
Akihiro
A
Maguchi
Hiroyuki
H
Kondo
Satoshi
S
Kashimura
Nobuichi
N
D001652:Bile Ducts / Q000002:abnormalities* / Q000293:injuries* / Q000503:physiopathology; D002758:Cholangiography; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D004065:Digestive System Abnormalities / Q000453:epidemiology; D004322:Drainage / Q000295:instrumentation / Q000379:methods; D016145:Endoscopy, Digestive System / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D007441:Intubation, Gastrointestinal / Q000295:instrumentation / Q000379:methods; D008297:Male; D008875:Middle Aged; D012307:Risk Factors