T-tube in Moderation: T-tube Drainage versus Primary Closure after Open Common Bile Duct Exploration for Common Bile Duct Stone: A Single Institution Experience

Abstract

Introduction: To discuss and compare outcomes and complications of routine T-Tube placement versus primary closure in patients who underwent open common bile duct exploration for choledocholithiasis. Methods: This is a randomized prospective analysis of 35 patients categorized as moderate to high risk for CBD stone who underwent open choledochotomy. Thirty (30) patients were included and were randomly divided into 2 groups: T-tube drainage (TD, n=20) and primary closure (PC, n=10). Morbidity was graded using the Clavien-Dindo (CD) classification. Results: Patients in the TD group had less overall complications than patients in the PC group (20% vs 30%, respectively; p=0.083); however, the TD group had more severe (CD Grade III or higher) complications than the PC group (75% vs 0% respectively; p=0.052). Complications included two patients with bile leak for pulled t-tube, post-op biliary stricture and acute kidney injury which required dialysis. Most of the complications in the PC group (3/10, or 30%) were minor complications (CD 1 or 2). There was no mortality in both groups. All 30 patients were followed-up for 3-12 months, with a median follow-up time of 6 months. Conclusion: There was no statistically significant difference between T-tube placement and primary closure in terms of morbidity and long-term outcomes. Primary closure of the choledochotomy after biliary exploration for common bile duct stones is a safe and feasible alternative to routine T-tube drainage in carefully selected cases.