Early Postoperative Outcome of Primary Closure versus T-Tube Drainage of Common Bile Duct after Open Choledocholithotomy

Abstract

Background: Choledocholithiasis is the formation of stones in the common bile duct (CBD). These stones are removed by performing CBD exploration and the closure can be done over T-tube or primarily without T-tube. The method of T-tube drainage comes with many complications and hence, nowadays, there is tendency to close CBD primarily to avoid the tube-related complications. Aims: To compare the early postoperative outcome of primary closure versus T-tube drainage after open choledocholithotomy. Methods: This quasi experimental study was carried out in the three units of the General Surgery department of Chittagong Medical College and Hospital, Chittagong, Bangladesh from July 2017 to June 2018. A total of 60 patients of 18 years or more in age, both male and female underwent open choledocholithotomy were enrolled in this study. The patients were divided into two groups. Thirty patients underwent primary closure were considered as the group I and rest 30 patients underwent T-tube drainage were considered as group II. All patients underwent per-operative choledochoscopy before primary closure or T-tube drainage. Statistical analyses of the results were obtained by using window-based computer software devised with Statistical Packages for Social Sciences (SPSS-22). Results: Thirteen (43.3%) patients belonged to age group 41–60 years in group I and 18 (60.0%) in group II. Male to female ratio was 1:1.5 and 1:1.73 in group I and group II, respectively. The mean CBD diameter was 16.6±0.12 mm in group I and 19.4±0.01 mm in group II. The difference was statistically significant (p< 0.05) between the two groups. The mean size of stone was 18.57±3.61 mm in group I and 18.87±4.38 mm in group II. It was observed that three (10.0%) patients had postoperative complications in group I and five (16.7%) in group II. The mean hospital stay was found to be 5.67±0.8 days in group I and 11.73±0.78 days in group II. The hospital stay was statistically significant (p< 0.05) between the two groups.  Conclusion: Primary closure of CBD after open choledocholithotomy is safe and associated with relatively lower complication rate in relation to T-tube drainage. Primary closure reduces the postoperative hospital stay significantly.

Keywords: open choledocholithotomy, primary closure, choledocholithiasis

Cite this Article

Md. Nur Hossain Bhuiyan, M.R. Khan, Md. Saiful Hoque, Gazi Jakir Hasan, Md. Saiful Islam. Early Postoperative Outcome of Primary Closure versus T-Tube Drainage of Common Bile Duct after Open Choledocholithotomy. Research & Reviews: Journal of Surgery. 2019; 8(1): 13–18p.