Primary closure versus T-tube drainage after open choledochotomy.

Autor:	Ambreen M; Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro, Sindh, Pakistan. banglani_90@hotmail.com, Shaikh AR, Jamal A, Qureshi JN, Dalwani AG, Memon MM
Jazyk:	angličtina
Zdroj:	Asian journal of surgery [Asian J Surg] 2009 Jan; Vol. 32 (1), pp. 21-5.
DOI:	10.1016/S1015-9584(09)60004-X
Abstrakt:	Background: 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.
Databáze:	MEDLINE
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