Modified laparoscopic choledocholithotomy T-tube drainage reduces the risk of bile leakage: A surgeon's experience

Factors Influencing Suture Difficulty of T-tube Fixation and Closure in Laparoscopic Common Bile Duct Exploration

“…Moreover, laparoscopic T-tube anastomosis and fixation is more difficult and can better represent the difficulty of endoscopic suture than that of primary suture of CBD. One reason is the interference of T-tube, the other is that TTD is often used in some complicated cases, such as acute suppurative cholangitis, severe inflammatory edema of the CBD, or inflammatory stricture of the sphincter of Oddi 1,3–6,10,19…”

“…One reason is the interference of T-tube, the other is that TTD is often used in some complicated cases, such as acute suppurative cholangitis, severe inflammatory edema of the CBD, or inflammatory stricture of the sphincter of Oddi. 1,[3][4][5][6]10,19 Difficult suture may lead to prolonged suture time and increased suture-related complications. In this series, some T-tube-related complications such as bile leak, bile peritonitis, and late bile duct stenosis did not occur during the intraoperative or postoperative period in any of the patients, which were significantly lower than that reported in the literature.…”

“…[5][6][7][8] After common bile duct (CBD) exploration, the next step is a latex rubber T-tube placement or primary suture of CBD. [9][10][11][12][13] However, despite many efforts have been made to improve laparoscopic suture technique by the way of training and simulation, laparoscopic suture remains timeconsuming and difficult to master during LCBDE, especially for beginners. 14 Difficult suturing can lead to prolonged suturing time and decreased suturing quality.…”