Application of a new self-shedding biliary stent in laparoscopic common bile duct exploration (with video)
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1.Department of General Surgery, Xixiang County People's Hospital, Xixiang, Shaanxi 723599, China;2.Department of General Surgery, Yulin Second Hospital, Yulin, Shaanxi 719000, China;3.Department of Hepatobiliary Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China

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    Abstract:

    Background and Aims Laparoscopic common bile duct exploration (LCBDE) is a traditional method for treating common bile duct stones. Intraoperative biliary stent implantation may reduce the risk of postoperative bile leakage but may give rise to prolonged retention or premature shedding of the stent. This study investigated the safety and effectiveness of implantation of a new type of self-shedding biliary stent in LCBDE for cholecystolithiasis with choledocholithiasis.Methods The clinical data of patients with concomitant cholecystolithiasis and choledocholithiasis treated in the First Affiliated Hospital of Xi'an Jiaotong University from June 2019 to December 2020 were retrospectively analyzed. Patients receiving LCBDE plus biliary stent implantation were selected as the observation group, and those undergoing LCBDE with primary closure were set as the control group. The stent used was 5 Fr in diameter and 5 cm in length, with a length scale marked in the main body, its anti-skid side wings opened toward the direction of the head to prevent the premature detachment or prolonged retention of the stent, and a spiral tail left outside the duodenal papilla for being pulled out under the drive of digestive tract fluid. The stent placement method was advancing the choledochoscope to the end of the common bile duct, endoscopically inserting a 0.035" guidewire through the duodenal papilla, using the outer sheath of the stone basket as a pusher to push the stent into the bile duct over the guide wire, pushing the stent while retrieving the choledochoscope when the 1-cm mark of the stent body passed through the inner orifice of the papilla, and removing the guidewire to complete the placement of the stent under the direct vision when the end of the stent completely disengages from the lens. The general data of patients, preoperative blood test results, the number and maximum diameter of common bile duct stones, the time for intraoperative biliary stent implantation, operative time, postoperative complications, and length of postoperative hospital stay were compared between the two groups, and the rate of stent shedding in observation group was recorded.Results Forty-three patients in the observation group and 52 patients in the control group were included. The general preoperative data, blood routine test, liver function parameters, common bile duct diameter and size of bile duct stones were comparable between the two groups (all P>0.05). The median time for stent implantation in observation group was 14 (10-20) min, but there was no significant difference in overall operative time between the two groups [125 (55-210) min vs. 116 (50-200) min, P>0.05]. In control group, there were 2 cases of mild bile leakage (<50 mL/d) after operation, which was improved after prolonging the abdominal drainage time. No bile leakage was observed in observation group, but there was no significant difference in the incidence of bile leakage between the two groups (P>0.05). Hyperamylasemia was observed in both groups, which caused no obvious clinical symptoms and was cured with conservative treatment. Its incidence rates showed no significant difference between the two groups (11.6% vs. 3.8%, P>0.05). There was no significant difference in the overall incidence of postoperative complications between the two groups (16.3% vs. 9.6%, P>0.05). The median time of abdominal drainage and length of postoperative hospital stay was significantly shorter in observation group than those in control group [1 (1-3) d vs. 2 (1-5) d; 2 (2-6) d vs. 3 (2-8) d, both P<0.05]. In observation group, the abdominal X-ray showed that the stents were all in place on postoperative day 2, the rate of stent detachment was 88.4% after two weeks, and all stents fell off one month after the operation.Conclusion Using the new type of self-shedding biliary stent in LCBDE is safe and effective, and it can reduce the time of abdominal drainage and length of postoperative hospitalization.

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YANG Xianwei, YANG Gang, DONG Dinghui, LIU Xuemin, LI Yu. Application of a new self-shedding biliary stent in laparoscopic common bile duct exploration (with video)[J]. Chin J Gen Surg,2023,32(2):181-189.
DOI:10.7659/j. issn.1005-6947.2023.02.003

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History
  • Received:April 05,2022
  • Revised:January 28,2023
  • Adopted:
  • Online: March 02,2023
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