Comparison between primary closure and T-tube drainage after open choledochotomy

Abstract

Background: Choledochotomy followed by T-tube drainage has been long the standard surgical treatment in many hospitals. However, the insertion of a T-tube is not without complications and the patients have to carry it for 2 weeks before removal. To avoid those complications associated with T-tube, we have performed primary closure of the common bile duct (CBD) after choledochotomy and removal of CBD stones. This study assesses the safety of primary closure of CBD and may help in its application in a wide scale. Objectives: To compare the clinical results of primary closure of (CBD) with T-tube drainage after open choledochotomy. Patients & methods: This comparative study was conducted at El-Demerdash Hospital & Ain Shams University Hospital from January 2008 to December 2008. Thirty patients were included in the study, 15 patients underwent primary closure and 15 patients underwent T-tube drainage. Results: There was no mortality in both groups. A T-tube was inserted in 15 patients and the CBD was closed primarily in 15 patients, there were no difference in the demographic characteristics or clinical presentations between the two groups. Compared with the T-tube group, the post-operative stay was significantly shorter, the hospital expenses significantly lower, and the incidences of overall postoperative complications and biliary complications were statistically and significantly lower in the primary closure group. Conclusion: Primary closure without external drainage after open choledochotomy is feasible and as safe as T-tube insertion.