Is primary closure of common bile duct a rational method after choledocholithotomy, in a low resource setting?

Autor: Sumitra Hagjer, Abdul Rahim Shaan, Yogesh Shukla
Rok vydání: 2017
Předmět:
Zdroj: Hellenic Journal of Surgery. 89:18-23
ISSN: 1868-8845
0018-0092
DOI: 10.1007/s13126-017-0372-8
Popis: Biliary obstruction, which is the interruption of bile flow from the liver to the small intestine, can occur at any level within the biliary system, Choledocholithiasis being one of the commonest causes. One of the surgical approaches to this condition is open choledocholithotomy and drainage. The aims of this study were to compare the outcomes after primary closure of common bile duct with T-tube insertion after choledocholithotomy. The objectives were to describe the demographic profile, to evaluate days of hospital stay, complications, incidence of retained stones and cost factor associated with procedure. A prospective study of 50 patients was carried out. Open cholecystectomy and choledocholithotomy were done using standard procedures, thereafter the patients were randomly divided into two groups: Group A (primary closure) & Group B (T-tube group) containing 25 patients each. The F:M ratio was 4:1. The mean age in the T-tube group was 43.72 years (SD 13.31) and in primary closure it was 36.68 years (SD 14.10). Two patients in the T-tube group developed transient bile leak following removal of T-tube. In the primary closure group no complications were noted. In patients who underwent T-tube drainage, the mean hospital stay was 14.44 days (SD 1.12), whereas in Primary Closure it was 4.04 days (SD 0.45). The mean expenditure for treatment in T-tube closure was Rs 708.2 ± 60.7, while in primary closure group it was Rs 520.6 ± 1.6. In the T-tube group, one case was reported with retained stone, the rest showed no evidence of retained stones on follow-up. In a limited resource setting, primary closure of the common bile duct is a safe and effective method that avoids the morbidity related to T-tube usage. It reduces the hospital stay and overall cost.
Databáze: OpenAIRE
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