Abstract
Closure of the common bile duct over T-tube after exploration is a widely practiced traditional method. However, its use may give rise to many complications. We do primary closure of common bile duct after exploration. Aim of the study is to see the efficacy and safety of the primary closure. Study was carried out to compare the results of both the techniques from 2006 to 2009 in the cases proven to have common bile duct stone with or without the features of obstructive jaundice. Post operative hospital stay and morbidities related to both the groups were recorded and analyzed. There were total 71 cases included in the study. Thirty one in T-tube group and 40 in primary closure group. T-tube was removed in most of the cases after three weeks where as average time of drain removal in primary closure group is 5.79 +/-1.79 days. Incidence of retained stone was equal in each group. Major complication in T-tube group is biliary peritonitis in four patients at the time of T-tube removal whereas none of the patient from primary closure group suffered from such major complication. Primary closure after the common bile duct exploration is safe and it helps to avoid the morbidities related to T-tube.
Highlights
Closure of the common bile duct over T-tube after exploration is a widely practiced traditional method
Major complication in T-tube group is biliary peritonitis in four patients at the time of T-tube removal whereas none of the patient from primary closure group suffered from such major complication
Primary closure after the common bile duct exploration is safe and it helps to avoid the morbidities related to T-tube
Summary
Closure of the common bile duct over T-tube after exploration is a widely practiced traditional method. Its use may give rise to many complications. We do primary closure of common bile duct after exploration. Aim of the study is to see the efficacy and safety of the primary closure. Common bile duct (CBD) stones have been managed historically by supraduodenal choledochotomy, stone removal and the duct repair around T-tube. As the incidence of retained stone was more than 10%, T-tube tract was used for per-cutaneous stone removal postoperatively.[1] The problems related to T-tube are a longer hospital stay, higher cost of hospitalization[2] and serious morbidity if the T-tube is dislodged or removed before the tract is developed. The T-tube is kept for 3-4 weeks before removal.[3] The most frequent complication of T-tube removal is bile leakage in 1-19% of cases.[4]. With the availability of per-operative cholangiography, choledochoscopy and JNMA I VOL 49 I NO. 3 I ISSUE 179 I JUL-SEP, 2010
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