Comparison of Primary Closure and T-tube Drainage after Open Choledocholithotomy
Tamanna Rahman Shanta *
Department of Surgery, PatuaKhali Medical College and Hospital, Patuakhali, Bangladesh.
Md. Abul Kalam Azad
Department of Surgery, Jamalpur Medical College, Jamalpur, Bangladesh.
Mahedi Afroz Shakil
Department of Surgery, International Medical College, Gazipur, Bangladesh.
Fahim Foysal Kollol
Department of Surgery, Mymensingh Medical College and Hospital, Mymensingh, Bangladesh.
Nabarun Biswas
Department of Surgery, Mymensingh Medical College and Hospital, Mymensingh, Bangladesh.
Mst Anjuman Ara
Department of Orthopaedic Surgery, Rajshahi Medical College and Hospital, Rajshahi, Bangladesh.
Noorjahan Akter
National Institute of Burn and Plastic Surgery, Dhaka, Bangladesh.
Amir-Al-Ahmed
Department of General Surgery, Mymensingh Medical College Hospital, Mymensingh, Bangladesh.
Md. Wahidul Islam
Department of General Surgery, Mymensingh Medical College Hospital, Mymensingh, Bangladesh.
Sharmin Akter Rime
Department of Paediatric Surgery, Mymensingh Medical College Hospital, Mymensingh, Bangladesh.
*Author to whom correspondence should be addressed.
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.
Keywords: Primary closure, T-tube closure, choledocholithotomy