Primary closure versus T-tube drainage after laparoscopic choledocholithotomy: a prospective randomized study

Abstract

Background: Traditionally laparoscopic common bile duct exploration is followed by T-tube placement because of which patients suffer problems related to T-tube thereby increasing the morbidity of patients. Primary closure of CBD following laparoscopic choledocholithotomy is now being considered as an alternative superior to the traditional method. This study is designed to analyse the outcome of primary CBD repair in terms of mean operation time, duration of hospital stay and post-operative morbidity.Methods: A prospective randomized study was done in which 40 patients at our institute and associated hospitals were divided into two groups to compare the results of primary closure to T-tube placement following laparoscopic choledocholithotomy.Results: 40 patients were included in this study. The mean operating time was observed to be 65±14.05 mins in Group A (primary closure) patients while that in case of Group B (T-tube drainage) patients was 95.25±9.66 mins with a p-value 0.0001 which is considered statistically significant. The average duration of hospital stay in Group A (primary closure) was 8.2 days which was much shorter than that of Group B (T-tube drainage) patients which was of 15.7 days. The post-operative complication was observed in 1 patient of Group A (primary closure) while post-operative complication occurred in 3 patients of Group B (T-tube drainage).Conclusions: This study indicates that primary repair following laparoscopic choledocholithotomy is a safer and more effective method than T-tube drainage and we strongly recommend this procedure in clinical practice.

T-Tube Use After Laparoscopic Common Bile Duct Exploration

“…A total of 369 articles were identified through the electronic database search (368 articles) and manual search (one article); the manually retrieved study 21 was identified from the reference list of one of the other relevant articles. 22 After reviewing the titles and abstracts of these obtained articles, 339 were excluded because they were irrelevant studies, noncontrol studies, systematic reviews, animal studies, or studies that focused on open common bile duct exploration (CBDE).…”

“…The full texts of the 30 remaining studies were then assessed. Finally, 26 studies 9,12,21,23–45 were eligible for this meta-analysis. Seven were randomized controlled trials, 9,21,23,24,38,42,43 and the other 19 were retrospective cohort studies or prospective cohort studies.…”

“…Finally, 26 studies 9,12,21,23–45 were eligible for this meta-analysis. Seven were randomized controlled trials, 9,21,23,24,38,42,43 and the other 19 were retrospective cohort studies or prospective cohort studies. Sixteen studies 9,12,21,23,26,28,30,33,34,37–41,43,44 compared LCBDE+PDC with LCBDE+TTD.…”

“…Seven were randomized controlled trials, 9,21,23,24,38,42,43 and the other 19 were retrospective cohort studies or prospective cohort studies. Sixteen studies 9,12,21,23,26,28,30,33,34,37–41,43,44 compared LCBDE+PDC with LCBDE+TTD. Eight studies 24,25,28,29,32,36,42,45 compared LCBDE+PDC+IBD with LCBDE+TTD; three studies 27,31,35 compared LCBDE+ PDC+EBD with LCBDE+TTD; and one study 28 compared three bile duct closure methods following LCBDE ( Table 1 ).…”

“…In the 16 studies 9,12,21,23,26,28,30,33,34,37–41,43,44 that compared LCBDE+PDC with LCBDE+TTD, 74 patients (7.5%) in the PDC group and 106 patients (12.8%) in the TTD group developed postoperative complications; the PDC group showed a significantly lower overall morbidity than did the TTD group (OR = 0.55, 95% CI = 0.39–0.76, P = .0004; no heterogeneity was found; I 2 = 0%; P = .91) ( Figure 1A ). Thirty-three of the 106 patients developed postoperative complications due to T-tube removal or accidental dislodgement in the TTD group 9,12,21,23,26,28,30,33,34,38,39,43 ( Table 2 ).…”