title: Sphincter of Oddi-preserving and T-tube-free laparoscopic management of extrahepatic bile duct calculi.
abstract: BACKGROUND
  The current management of choledocholithiasis remains a controversial topic. Popular options for treatment include preoperative endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (EST) followed by laparoscopic cholecystectomy (LC), or LC and laparoscopic common bile duct exploration (LCBDE) with T-tube decompression. Some concerns suggest that sphincterotomy has significant long-term complications as a result of sphincter of Oddi (SO) dysfunction, and T-tube decompression is historically associated with many complications and discomfort. The purpose of this study was to demonstrate our simple, safe techniques of LCBDE without a T-tube and with an intact SO.
  
  
  METHODS
  Between April 2006 and July 2009, a total of 44 selected patients with common bile duct (CBD) stones underwent laparoscopic exploration at our institution. Of 44 laparoscopic choledochotomies, primary choledochorrhaphy was performed on patients with preoperatively installed endoscopic retrograde biliary drainage (ERBD) tubes (n = 10, 22.73%) or endonasobiliary drainage (ENBD) tubes (n = 10, 22.73%) and on patients with intraoperative biliary drainage C-tubes (n = 9, 20.45%) or pigtail J biliary drainage tubes (n = 15, 34.09%).
  
  
  RESULTS
  The mean operating time for the ENBD, ERBD, J-tube, and C-tube groups were 97.8, 96.2, 102.1, and 98.7 min, respectively. There were no conversions to open surgery, and no intraoperative complications were experienced in any group. CBD clearance was achieved in 43 patients (97.73%). The mean lengths of follow-up for the ENBD, ERBD, J-tube, and C-tube groups were 27.0, 26.7, 23.8, and 30.4 months, respectively; and none of the patients developed major biliary complications including recurrent stones.
  
  
  CONCLUSIONS
  Laparoscopic primary closure with internal and external biliary drainage tubes is safe and an effective alternative to T-tube placement, especially for younger patient groups able to endure bile duct exploration. Sphincter of Oddi function is well preserved to prevent recurrent bile duct stones and bile duct cancer. Procedures are safe with great feasibility.
authors.affiliation: Department of Biliary and Vascular Surgery, ShengJing Hospital of China Medical University, #36 SanHao Street, HePing District, Shenyang, Liaoning 110004, People's Republic of China.
authors.forename: Chun-Chih
authors.initials: CC
authors.lastname: Chen
authors.forename: Shuo-Dong
authors.initials: SD
authors.lastname: Wu
authors.forename: Yu
authors.initials: Y
authors.lastname: Tian
authors.forename: Ernest Amos
authors.initials: EA
authors.lastname: Siwo
authors.forename: Xin-Tao
authors.initials: XT
authors.lastname: Zeng
authors.forename: Guang-Hui
authors.initials: GH
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017734:Bile Ducts, Extrahepatic; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D002769:Cholelithiasis / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009803:Sphincter of Oddi