Primary closure versus T-tube drainage after open choledochotomy

Area of Science:

• Gastroenterology
• Surgical Innovation
• Biliary Surgery

Background:

• T-tube drainage is a standard surgical treatment for choledocholithiasis, especially where minimally invasive options are unavailable.
• However, T-tube usage is associated with potential complications.
• Primary closure of the common bile duct (CBD) is explored as an alternative to mitigate these risks.

Purpose of the Study:

• To compare clinical outcomes of primary CBD closure versus T-tube drainage after open choledochotomy.
• To evaluate the safety and feasibility of primary CBD closure for broader implementation.

Main Methods:

• A comparative study involving 35 patients undergoing open choledochotomy for choledocholithiasis.
• 16 patients received primary CBD closure, while the remainder had T-tube drainage.

Main Results:

• Primary CBD closure resulted in a shorter postoperative hospital stay (5.56 days vs. 13.6 days) and significantly lower treatment costs (USD 194.5 vs. USD 548.6) compared to T-tube drainage.
• Bile leakage occurred in 6.3% of primary closure patients and 10.5% of T-tube patients, with no biliary peritonitis in the primary closure group.
• No retained stones or recurrence of CBD stones were observed in either group over a median 6-month follow-up.

Conclusions:

• Primary CBD closure is a safe and effective alternative to T-tube drainage following open choledochotomy.
• This approach offers significant cost savings and reduced hospital stay.
• Primary closure demonstrates potential for wider adoption in managing choledocholithiasis.