Acute suppurative cholangitis: comparison of internal and external biliary drainage

Forty-eight patients with acute cholangitis who presented with postcholocystectomy choledocholithiasis are reported on in this study. As soon as the general condition of the patients had improved, or as soon as the fluid balance was established, usually within 48 hours of admission, the patients were divided into two groups: group A (28 patients) under went choledochoduodenostomy, and group B (20 patients) had T-tube drainage. The results demonstrate that internal biliary drainage in patients with acute cholangitis is associated with lower mortality and morbidity, and that further recurrent choledocholithiasis is eliminated after choledochoduodenostomy, which was the drainage procedure used exclusively in this series of patients. We believe that this difference in results is due first to the elimination of the possibility of exogenous contamination through the T tube when internal drainage is used, and second to the difference in the caliber and length of th two drainage systems.