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Cost‐effective method for laparoscopic choledochotomy
Author(s) -
Griniatsos John,
Karvounis Evangelos,
Arbuckle James,
Isla AlbertoMartinez
Publication year - 2005
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2005.03287.x
Subject(s) - medicine , surgery , common bile duct , stent , univariate analysis , biliary stent , laparoscopy , biliary drainage , general surgery , multivariate analysis
Background: Recent reports have noted that postoperative complications following open or laparoscopic choledochotomy for common bile duct (CBD) exploration are mainly related to the T‐tube presence, and that there has been no trend of decrease in the laparoscopic era. Laparoscopic endobiliary stent placement with primary closure of the CBD has been proposed as a safe and effective alternative to T‐tube placement. Methods: Between January 1999 and January 2003, 53 consecutive patients suffering from proven choledocholithiasis underwent laparoscopic common bile exploration (LCBDE) via choledochotomy. In the early period, a T‐tube was placed at the end of the procedure (group A, n = 32) while, from June 2001 onwards, laparoscopic biliary stent placement and primary CBD closure were chosen as the drainage method (group B, n = 21). Results: Six patients developed T‐tube‐related complications postoperatively. Univariate analysis revealed statistically significant lower morbidity rate and shorter postoperative hospital stay for the stent group. Although not statistically significant, a median saving of £780 per patient was observed in the stent group. Conclusion: Biliary endoprosthesis placement following laparoscopic choledochotomy avoids the well‐known complications of a T‐tube, leading to a shorter postoperative hospital stay. The method is safe and effective and it should also be considered as cost‐effective compared to T‐tube placement. Further studies are required in order to document cost‐effectiveness of the method.