Comparison of Primary Closure and T-tube Drainage after Open Choledocholithotomy

Abstract

Background: Choledocholithotomy followed by closure over a T-tube has long been a standard surgical treatment for choledocholithiasis. However, several authors have supported the primary closure of the duct immediately after exploration. This study was conducted to compare the clinical short-term outcomes of primary closure of the common bile duct and T-tube drainage. Methods: This prospective comparative study was conducted at the Department of Surgery, Mymensingh Medical College and Hospital, from January 2021 to June 2022. A total of 50 clinically diagnosed cases of choledocholithiasis patients after fulfilling the inclusion criteria were included and purposively divided into primary closure group (Group I, n=25) and closure over T-tube group (Group II, n=25). All patients were evaluated by history, physical examination and investigation. The data was collected in a semi structured questionnaire. Finally data analysis was done by SPSS 26 version. A standard guideline was followed during post-operative management. Results: The mean (±SD) age of patients was 48.5±8.60 and 48.20±9.86 years in primary closure and T-tube closure respectively with female predominance (72% and 60% in the primary closure and T-tube closure group respectively). There was a significant difference found between group-I & group-II regarding mean operative time (87.8±4.58 vs 102.2±3.82 mins, p<0.001) and length of hospital stay (5.64±1.36 vs 15.08±1.32 days, p<0.001). There was no significant difference between group-I and group-II patients regarding post-operative early complications. T-tube related complications were only seen in group-II. Conclusion: Primary closure has similar post-operative complications but shorter duration of operation and length of hospital stay than T-tube closure in the treatment of CBD stone after open choledocholithotomy.