primary closure versus t-tube drainage after open choledochotomy
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ID: 212813
2009
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Abstract
Choledochotomy followed by T-tube has long been a standard surgical treatment for choledocholithiasis. It is still a preferred choice in many hospitals where minimal invasive procedures are not feasible. The use of T-tube is not without complications. To avoid the complications associated with T-tube, we have performed primary closure of the common bile duct (CBD) after exploration. This pilot study assesses the safety of primary closure of CBD, which would help form a basis for implementation on a wider scale.
Objective: To compare the clinical results of primary closure with T-tube drainage after open choledochotomy and assess the safety of primary closure for future application on a greater mass.
Patients and Methods: This comparative study was conducted at surgical unit IV Liaquat University of Medical and Health Sciences, Jamshoro, from January 2007 to December 2007. Thirty-five patients were included in the study of which 16 patients underwent primary closure.
Results: Thirty-five patients were included in the study. The mean age of patients who had primary closure done (n = 16) was 46.0 ± 16.8 and there were two (12.5%) males and 14 (87.5%) females. After primary closure of the CBD, bile leakage was noted in one patient (6.3%), which subsided without any biliary peritonitis as compared to the T-tube group in which two patients (10.5%) had bile leakage. Postoperative jaundice was seen in one patient (5.3%) 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 USD548.6 ± 88.5. The median follow 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.
| Reference Key |
ambreen2009asianprimary
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| Authors | ;M. Ambreen;A.R. Shaikh;A. Jamal;J.N. Qureshi;A.G. Dalwani;M.M. Memon |
| Journal | journal of molecular structure |
| Year | 2009 |
| DOI |
10.1016/S1015-9584(09)60004-X
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