title: Primary closure versus T-tube drainage after open choledochotomy.
abstract: BACKGROUND
  Choledochotomy followed by T-tube has long been a standard surgical treatment for choledocholithiasis. It is still a preferred choice in many hospitals where minimal invasive procedures are not feasible. The use of T-tube is not without complications. To avoid the complications associated with T-tube, we have performed primary closure of the common bile duct (CBD) after exploration. This pilot study assesses the safety of primary closure of CBD, which would help form a basis for implementation on a wider scale.
  
  
  OBJECTIVE
  To compare the clinical results of primary closure with T-tube drainage after open choledochotomy and assess the safety of primary closure for future application on a greater mass.
  
  
  METHODS
  This comparative study was conducted at surgical unit IV Liaquat University of Medical and Health Sciences, Jamshoro, from January 2007 to December 2007. Thirty-five patients were included in the study of which 16 patients underwent primary closure.
  
  
  RESULTS
  Thirty-five patients were included in the study. The mean age of patients who had primary closure done (n = 16) was 46.0 +/-16.8 and there were two (12.5%) males and 14 (87.5%) females. After primary closure of the CBD, bile leakage was noted in one patient (6.3%), which subsided without any biliary peritonitis as compared to the T-tube group in which two patients (10.5%) had bile leakage. Postoperative jaundice was seen in one patient (5.3%) who had a T-tube because of a blockage of CBD. Not a single patient had a retained stone in both groups as well as no recurrence of CBD stones. The postoperative hospital stay after primary closure was 5.56 +/-1.1 days as compared to after T-tube drainage which was 13.6 +/-2.3 days. The total cost of treatment in patients who underwent primary closure was USD194.5 +/-41.5 but after T-tube drainage it was USD548.6 +/-88.5. The median follow up duration for both groups was 6 months.
  
  
  CONCLUSIONS
  Primary CBD closure is a safe and cost effective alternative to routine T-tube drainage after open choledochotomy.
authors.affiliation: Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro, Sindh, Pakistan. banglani_90@hotmail.com
authors.forename: M
authors.initials: M
authors.lastname: Ambreen
authors.forename: A R
authors.initials: AR
authors.lastname: Shaikh
authors.forename: A
authors.initials: A
authors.lastname: Jamal
authors.forename: J N
authors.initials: JN
authors.lastname: Qureshi
authors.forename: A G
authors.initials: AG
authors.lastname: Dalwani
authors.forename: M M
authors.initials: MM
authors.lastname: Memon