Primary Closure Versus T-tube Drainage After Open Choledochotomy

BACKGROUND: Choledochotomy followed by T-tube has long been a standard surgical treatment for choledocholithiasis. It is still a preferred choice in many hospitals where minimal invasive procedures are not feasible. The use of T-tube is nor without complications. To avoid the complications associated with T-tube, we have performed primary closure of the common bile duct (CBD) after exploration. This pilot study assesses the safety of primary closure of CBD, which would help form a basis for implementation on a wider scale. OBJECTIVE: To compare the clinical results of primary Closure with T-tube drainage after open choledochotomy and assess the safety of primary closure for future application on a greater mass. PATIENTS AND METHODS: This comparative Study was conducted at surgical unit IV Liaquat University of Medical and Health Sciences, Jamshoro, from January 2007 to December 2007. Thirty-Five patients were included in the Study of which 16 patients underwent primary closure. RESULTS: Thirty-five patients were included in the study. The mean age of patients who had primary closure done (n = 16) was 46.0 +/- 16.8 and there were two (12.5%) males and 14 (87.5%) females. After primary closure of the CBD, bile leakage was noted in one patient (6.3%), which subsided without any biliary peritonitis as compared to the T-tube group in which two patients (10.5%) had bile leakage. Postoperative jaundice was seen in one patient (5.3%) who had a T-tube because of a blockage of CBD. Not a single patient had a retained stone in both groups as well as no recurrence of CBD stones. The Postoperative hospital stay after primary closure was 5.56 +/- 1.1 days as compared to after T-tube drainage which was 13.6 +/- 2.3 days. The total cost of treatment in patients who underwent primary closure was USD 194.5 +/- 41.5 but after T-tube drainage it was USD548.6 +/- 88.5. The median follow up duration for both groups was 6 months. CONCLUSION: Primary CBD closure is a safe and cost effective alternative to routine T-tube drainage after open choledochotomy. [Asian J Surg 2009;32(1):21-5]