title: Is a T-tube necessary after common bile duct exploration?
abstract: BACKGROUND
  T-tube drainage used to be standard practice after surgical choledocholithotomy, but there is now a tendency in some centers to close the common bile duct (CBD) primarily. This study was designed to review the complications associated with T-tube drainage after CBD exploration and to determine whether primary closure of the bile duct reduces postoperative morbidity.
  
  
  METHODS
  A retrospective audit was performed on patients undergoing CBD exploration between July 1997 and March 2007, who were identified from the theatre database of one teaching hospital. Intraoperative findings and postoperative complications were recorded from the clinical notes.
  
  
  RESULTS
  During the study period, 158 patients (97 women; median age 65 (range, 25-90) years) underwent CBD exploration. A T-tube was inserted in 91 patients (group I) and the CBD was closed primarily in 67 (group II). One or more biliary complications occurred in 26 patients (16.5%): 20 (22.0%) in group I and 6 (8.9%) in group II (p = 0.03). In group I, 15 had a biliary leak (3 needed reoperation), 2 had accidental slippage of the tube, 2 an entrapped T-tube, and 1 a retained stone. In group II, six patients had biliary leakage, two of whom were re-explored. Six patients in group I also had peritubal infection, necessitating the use of antibiotics. There were three deaths: two in group I (1 T-tube-related) and 1 in group II (p = 1, not significant).
  
  
  CONCLUSIONS
  There is a lower biliary complication rate associated with primary closure of the CBD than after T-tube drainage.
authors.affiliation: Division of Gastrointestinal Surgery, Wolfson Digestive Diseases Centre, Nottingham University Hospitals, Queen's Medical Centre, E Floor, West Block, Nottingham, NG7 2UH, United Kingdom.
authors.forename: Irfan
authors.initials: I
authors.lastname: Ahmed
authors.forename: Charita
authors.initials: C
authors.lastname: Pradhan
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Beckingham
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Brooks
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Rowlands
authors.forename: Dileep N
authors.initials: DN
authors.lastname: Lobo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001662:Biliary Tract Surgical Procedures / Q000295:instrumentation*; D042883:Choledocholithiasis / Q000601:surgery*; D003135:Common Bile Duct / Q000601:surgery; D004322:Drainage; D005260:Female; D006801:Humans; D007440:Intubation / Q000009:adverse effects*; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D012189:Retrospective Studies