Choledochotomy: primary closure versus T-tube. A prospective trial

Area of Science:

• Gastroenterology
• Surgical Procedures
• Biliary Tract Surgery

Background:

• Exploratory choledochotomy is often performed for common bile duct lithiasis.
• The management of the choledochotomy after stone extraction remains a subject of debate.
• T-tube drainage has been the traditional approach, but primary closure is an alternative.

Purpose of the Study:

• To compare the outcomes of primary closure versus T-tube drainage after exploratory choledochotomy for gallstones.
• To evaluate complications, hospital stay, and long-term effects.

Main Methods:

• A prospective trial was conducted from January 1986 to December 1988.
• Twenty-two patients were randomized into two groups: primary closure (P, n=11) and T-tube drainage (T, n=11).
• Patients were matched for age and risk factors. Preoperative alkaline phosphatase, complications, and hospital stay were recorded.

Main Results:

• Preoperative alkaline phosphatase levels were significantly lower on postoperative days 2 and 7 in the primary closure group (p < .025).
• Postoperative hospital stay was shorter in the primary closure group (12 days vs. 14 days, p < .05).
• One case of bile leakage without peritonitis occurred in the primary closure group. Infectious complications were similar in both groups (1 each).

Conclusions:

• Primary closure of the common bile duct after exploratory choledochotomy for lithiasis is a safe and attractive procedure within specific exclusion criteria.
• It offers benefits such as reduced hospital stay and comparable safety to T-tube drainage.