CHOLEDOCHORRAPHY (PRIMARY REPAIR) VERSUS T-TUBE DRAINAGE AFTER OPEN CHOLEDOCHOTOMY

Authors

  • Nadia Saeed
  • Muhammad Tauqeer Nasir
  • Muhammad Iqbal Khan
  • Ghulam Asghar Channa

Abstract

Background: T-tube drainage used to be standard practice after surgical choledochotomy, but there isnow a tendency in some canters to close the common bile duct primarily. This study was designed tocompare the clinical results of primary closure with T-tube drainage after open choledocotomy andassess the safety of primary closure for future application. Methods: This study was conducted atsurgical Unit-3, ward 26 Jinnah Postgraduate Medical Centre Karachi, from January 2007 to January2008. Forty patients were included in this study out of which 20 underwent primary closure and 20 Ttube placements. It was Quasi-experimental, non-probability, purposive sampling. Main outcomemeasures were operating time, duration of hospital stay, and postoperative complications. SPSS-10 wasused for data analysis. Results: The age of patients in the study ranged from 29–83 years. There were 3male while 37 female patients. Group-1 consisted of 20 patients underwent primary closure aftercholedocotomy, while Group-2 also consisted of 20 patients underwent T-tube drainage after ductexploration. Mean hospital stay in Group-1 patients was 7.63 days while in group 2 it was 13.6 days.Overall complication rate in group 1 was 15%, biliary leakage in 1 (5%), jaundice in 1 (5%), woundinfection in 1 (5%). No re-exploration was required in Group-1. In Group-2 overall complication ratewas 30%, biliary leakage in 2 (2%), jaundice in 1 (5%), dislodgement of T-tube in 1 (5%), woundinfection in 1 (5%), and sepsis in 1 (5%) patients. Re-exploration was done in one patient. Conclusion:Primary closure of Common Bile Duct (CBD) is a safe and cost-effective alternative procedure toroutine T-tube drainage after open choledocotomy.Keywords: Open choledocotomy, Primary closure, choledocholithiasis

References

Perez G, Escalona A, Jarufe N, Ibáñez L, Viviani P, García

C, et al. Prospective randomized study of T-tube versus

biliary stent for common bile duct decompression after open

choledochotomy. World J Surg 2005;29:869–72.

Ahrendt SA, Pitt HA, Biliary tract. In: Townsend M, Ed.

Sabiston Textbook of Surgery. Philadelphia: WB Saunders;

p. 486–92.

Thornton JK. Observation on additional cases illustrating

hepatic Surgery. Lancet 1891;137:763–4.

Halstead WS. Contributions to surgery of the bile passages,

especially of the common bile duct. Bull John Hopkins Hosp

;106:1–11.

Mirrizi PL. Primary suture of the common bile duct in

choledocholithiasis. Arch Surg 1942;44(1):44–54.

Collin PG, Redwood C, Wynne-Jones J. Common bile duct

without intraductal drainage following choledochotomy. Br J

Surg 196;47:661–7.

Sawyer JL, Herrington JL, Edward WH. Primary closure of

the CBD. Am J Surg 1965;109:107–12.

Collin PG. Further experience with common bile duct suture

without intraductal drainage following choledochotomy. Br J

Surg 1967;54:854–6.

Keighley MBR, Burdon DW, Baddeley RM, Dorricott

NJ, Oates GD, Watts GT, et al. Complication of

supraduodenal choledochotomy: a comparison of three

methods of management. Br J Surg 1976;63:754–58.

Vassilakis JS, chattopadhyay DK, Irvin TT, Duthie Hl.

Primary closure of common bile duct after elective

choledochotomy. J R Coll Surg Edinb 1979;24(3):156–8.

Sorensen VJ, Buck JR, Chung SK, Fath JJ, Horst HM, Obeid

FN. Primary common bile duct closure following exploration

of the common bile duct: an effective alternative to routine

biliary drainage. Am J Surg 1994;60:451–4.

Seale Ak, Ledet WP. Primary common bile duct closure.

Arch Surg 1999;134:22–4.

Sheen-chen SM, Chou FF. Choledochotomy for biliary

lithiasis: is routine T-tube drainage necessary? A prospective

controlled trial. Acta Chir Scand 1990;156:387–90.

De Roover D, Vanderveken M, Gerard Y. Choledochotomy:

primary closure versus T-tube. A prospective trial. Acta Chir

Belg 1989;89:320–24.

William JA, Treacy PJ, Sidey P, Worthley CS, Townsend

NC, Russell EA. Primary duct closure versus T-tube drainage

following exploration of the common bile duct. Aust NZ J

Surg 1994;64:823–6.

Lygidakis NJ. Choledochotomy for biliary lithiasis: T-tube

drainage or primary closure. Effects on prospective

bacteremia and T-tube bile infection. Am J Surg

;46:254–6.

Gillat DA, May RE, Kennedy R, Longstaff AJ. Complication

of T-tube drainage of the common bile duct. Ann R Coll Surg

;67:370–1.

Gharaibeh KI, Heiss HA, Biliary leakage following T-tube

removal. Int surg 2000;85:57–63.

Rovere J. Bile leakage following T-tube removal. Radiology

;144:267–70.

Kacker LK, Mittal BR, Sikora SS, Ali W, Kapoor

VK, Saxena R, et al. Bile leak after T-tube removal: a

scintigraphy study. Hepatogastroenterology 1995;42:975–8.

JelasoDV, Hirschfield JS. Jaundice from impacted sediment

in a T-tube: recognition and treatment. Am J Roentgenol

;127;413–5.

Haq A, Morris J, Goddard C, Mahmud S, Nassar AH.

Delayed cholangitis resulting from a retained T-tube

fragments encased within a stone: a rare complication. Surg

Endosc 2002;16:714.

Rozario A, Thomas PG, Pais A, Ravindra KV, Rao V

Asymptomatic T-tube remnant in common bile duct. Indian J

Gastroenterol 1999;18:180–1.

Chaudry A, Salunkhe S, Anand BS, Aranya RC. Post

cholecystectomy syndrome due to broken T-tube. Indian J

Gastroenterol 1991;10:18–9.

Lygidakis NJ. Hazards following T-tube removal after

choledochotomy. Surg Gynecol Obstet 1986;163:153–5.

Ahmad I, Pradhan C, Beckingham I, brooks J, Rowlands

BJ, Lobo DN. Is a T-tube necessary after common bile duct

exploration? World J Surg 2008;32:1485–8.

Ambreen M, Shaikh AR, Jamal A, Qureshi JN, Dalwani

AG, Memon MM. Primary closure versus T-tube drainage

after open choledochotomy. Asian J Surg 2009;321:21–5.

Zhang LD, Bie P, Wang SG, Ma KS, Dong JH. Primary duct

closure versus T-tube drainage following laparoscopic

choledochotomy. Zhonghua Wai Ke Za Zhi 2004;42:520–3.

Makinen AM, Matikainen M, Nordback I. T-tube drainage is

needed after routine common bile duct: results of a

randomized trial. Surg Res Commun 1989:6(4):299–302.

Haidar J, Aziz A, Khan l, Alam SN. Primary closure of

common bile duct after open choledochotomy. J Surg Pak

;14(4):173–5.

Published

2012-03-01

Issue

Vol. 24 No. 1 (2012): JOURNAL OF AYUB MEDICAL COLLEGE, ABBOTTABAD

Section

ORIGINAL ARTICLE

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