Is primary closure a feasible and acceptable option in the era of t-tube-free common bile duct exploration for choledocholithiasis?

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Abstract

Introduction
Common bile duct exploration (CBDE) has the advantage of managing cholecystocholedocholithiasis with single-stage procedure. There is still a debate about the benefits and drawbacks after T-tube usage. The aim of this study was to evaluate the value of primary common bile duct (CBD) closure and routine T-tube usage after CBDE.
Patients and methods
A total of 220 patients underwent CBDE by means of choledochotomy for common bile duct stones. Patients were divided into two groups. Group A included 63 patients who were managed with primary closure of the CBD, and group B included 157 patients who were managed using T-tube after assumed CBD clearance. Demographics, preoperative radiology, intraoperative findings, and postoperative complications were collected and analyzed between the two groups.
Results
Among the study patients, 138 patients (63%) underwent laparoscopic common bile duct exploration: 36 patients (57%) in group A and 102 patients (65%) in group B. Wound infection and abdominal collections were significantly more obvious in group B patients (<0.004 and <0.003, respectively). There was no statistically significant difference in bile leakage between the two groups as it was encountered in one patient (1.6%) in group A and in four patients (2.6%) in group B (=0.065). Residual stones were encountered in 11 patients (5%). Hospital stay was significantly longer in group B patients; the mean hospital stay was 4 days (range=3–35 days) in group B versus 3 days (range=1–13 days) in group A (<0.001).
Conclusion
We encourage primary CBD closure over the use of T-tube, as it provides a more comfortable postoperative course, shorter hospital stay, and is more accepted by patients.

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