title: Does laparoscopic approach impair T-tube-related sinus-tract formation?
abstract: OBJECTIVE
  Postoperative morbidity after bile duct exploration with T-tube insertion is mainly related to tube removal and incomplete sinus-tract formation leading to serious complications. Laparoscopic surgery reduces abdominal adhesion formation and diminishes tissue trauma and inflammatory response to surgery, which is essential for sinus-tract formation. This study evaluates if complication rate of T-tube removal is increased after laparoscopic bile duct exploration.
  
  
  METHODS
  Between January 2004 and January 2011, 94 patients underwent a T-tube insertion following choledocolithotomy (44 and 50 patients in the laparoscopic and open surgery group, respectively). Epidemiological data, preoperative characteristics, day of tube removal, and morbidity rates were analyzed.
  
  
  RESULTS
  Global T-tube removal-related biliary complication rate was 14.9% (18.2% in the laparoscopic group vs. 12% in the open surgery group). Although the day of T-tube removal was significantly delayed, there was a slight increased incidence of biliary peritonitis requiring reintervention in the laparoscopic surgery group (6.9% vs. 2%).
  
  
  CONCLUSIONS
  We reveal that T-tube removal is associated with significant morbidity. There was no statistical difference between the laparoscopic and the open surgery group, although global biliary complications after tube removal were slightly increased and bile spillage was worse delimited when T-tube was inserted laparoscopically. Laparoscopic approach may diminish inflammatory response and adherence development and impair, and therefore sinus-tract formation.
authors: Department of Surgery, University of Seville, Sevilla, Spain. pabloparra@aecirujanos.es
authors: Pablo
authors: P
authors: Parra-Membrives
authors: Dario
authors: D
authors: Martínez-Baena
authors: Macarena
authors: M
authors: Márquez-Muñoz
authors: Verónica
authors: V
authors: Pino-Díaz
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D042883:Choledocholithiasis / Q000601:surgery*; D002768:Choledochostomy / Q000379:methods; D020878:Device Removal / Q000379:methods; D004322:Drainage / Q000295:instrumentation; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic / Q000379:methods