Comparative assessment between Primary Closure versus T-tube Drainage after Choledochotomy

Abstract

Introduction: Conventional treatment of common choledocholithiasis includes T-tube insertion after endoscopic retrograde cholangiopancreatography or common bile duct examination. The aim of this study is to demonstrate that treatment of patients with gallstones by laparoscopic common choledochotomy is safe and feasible with primary gallstone obstruction. Objective: To compare the clinical outcomes of primary closure and T-tube drainage after open common choledochotomy. Methods & Materials: This comparative study was conducted from January to June 2022 at the Department of Hepatobiliary Surgery, Enam Medical College and Hospital, Savar, Bangladesh. 50 patients were included in the study, of which 20 underwent primary closure. The patient underwent routine laboratory tests, including a complete blood count, liver function tests, coagulation tests, and abdominal ultrasound. Results: 50 patients were included in the study. The mean age of patients who had primary closure done (n=20) was 46.0±16.8 and there were 3 (15.0%) males and 17 (85.0%) females. After primary closure of the CBD, bile leakage was noted in one patient (5.0%), which subsided without any biliary peritonitis as compared to the T-tube group in which two patients (10.0%) had bile leakage. Postoperative jaundice was seen in one patient (6.6%) 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 USD194.5 ± 41.5 but after T-tube drainage it was USD 548.6 ± 88.5. The median follows 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.