Open common bile duct exploration without T-tube insertion- two decade experience from a limited resource setting in the Caribbean.

Abstract

Despite advancements in gallbladder surgery with the introduction of endoscopic and laparoscopic techniques, many surgeons, especially in the developing world, still perform open cholecystectomy with common bile duct (CBD) exploration for choledocholithiasis. The purpose of the study is to report the outcomes of a case series of open CBD exploration without the use of T-tubes. A retrospective chart review of all consecutive open CBD exploration done by the first author over a period of 23 years was conducted. Demographic data, preoperative investigations, the surgical techniques and perioperative outcomes were recorded. Of 690 open cholecystectomies performed during the study period, 108 had common bile duct exploration. In 94 cases this was done via a supraduodenal choledochotomy, in 10 cases via a transduodenal sphincteroplasty and in 4 cases via the cystic duct. In 90 cases, a simple choledochotomy and primary closure was done while in 4 cases choledocho-duodenostomy was required. Eighty-seven percent of surgeries were done on elective basis and 13% on an emergency basis and no T-tubes were used in any patients. The mean hospital length of stay was 3.2 days and the perioperative morbidity was negligible. In a limited resource setting, there is still a role for open CBD exploration and primary closure without the necessity of T-tubes and stents as evidenced by a good perioperative patient outcome.