A randomized comparison of primary closure and T-tube drainage of the common bile duct after laparoscopic choledochotomy

Abstract

This study showed that primary CBC closure after laparoscopic choledochotomy was a viable alternative to mandatory T-tube drainage.

Primary closure after common bile duct exploration versus T-tube drainage: a prospective randomized study and review of literature

“…Regardless of the technique, the practice of using T-tubes versus primary closure of the bile duct is a subject of discussion, now days the trend is towards primary closure Isla AM et al Many authors have advocated primary Khaled Ahmed El-Dabee et al closure of the CBD following stone removal Wills VL et al Primary closure without a T-tube is safe and associated with a lower complication rate Cuschieri et al The four requirements for a safe and successful primary closure of common bile duct are patent Vater's ampulla, complete removal of all intra-ductal calculi, absence of pancreatic pathology and meticulous suture of the duct. 21,22 This randomized and prospective study shows that hospital stay in the T-tube group (5 -15 in primary group versus 8 -25 in T-tube) was longer than primary closure group which is in agreement with studies conducted by Zhang et al, Ambreen et al and Kyoun Tah Noe et al [23][24][25] In our study In T-tube group, wound infections, biliary fistula around T-tube were more common. The main drawback of T-tube was that it was uncomfortable, require continuous management, and it restricts the patient's activity because of risk of dislodgement.…”

Primary Closure and Rate of Bile Leak following Laparoscopic Common Bile Duct Exploration via Choledochotomy

“…However, the insertion of a T-tube is associated with a complication rate of 15%, which includes fluid and electrolyte disturbances, localized pain, a dislodged T-tube, biliary stricture, and bile leak when the T-tube is in situ or after its removal, without any significant differences between open and laparoscopic explorations [12,16,17]. This led several authors to perform laparoscopic primary duct closure after choledochotomy [18,19,20]. They found it to be feasible, safe, and cost-effective to perform such a closure after laparoscopic choledochotomy.…”

Primary closure versus T-tube drainage after common bile duct exploration for choledocholithiasis

“…These patients may require surgical intervention to remove stones, such as choledochotomy, in which indications include the history or presence of any of the following: history of elevated liver function tests, history or presence of jaundice, biliary pancreatitis, radiographic evidence of a dilated ductal system, and radiographic visualization of common bile duct stones. Following common bile duct (CBD) exploration and stone removal, the choice lies between primary closure and T-tube drainage [3,[6][7][8].…”

“…Some of these complications are serious, such as tract infection and bile leak resulting from T-tube displacement or early removal without adequate tract formation [3], which can lead to reoperation and even death, particularly in elderly patients. In addition, the patients have to carry it for several weeks before removal and suffer from significant discomfort and delayed return to work [6,8]. In particular, the availability and the routine application of choledochoscopy and endoscopic retrograde choledochopancreatography (ERCP) have reduced the importance of these indications for T-tube drainage [11][12][13][14].…”