Is the use of T-tube necessary after laparoscopic choledochotomy?
BACKGROUND
Traditionally, the common bile duct (CBD) is closed with T-tube drainage after choledochotomy and removal of CBD stones. However, the insertion of a T-tube is not without complication.


OBJECTIVE
This randomized study was designed to compare the use of T-tube and primary closure of choledochotomy after laparoscopic choledochotomy to determine whether primary closure can be as safe as closure with T-tube drainage.


METHODS
Between February 2006 and June 2009, 122 consecutive patients with proven choledocholithiasis had laparoscopic choledochotomy. They were randomized into two equal groups: T-tube (n = 61) and primary closure (n = 61). Demographic data, intraoperative findings, postoperative complications, and postoperative stay were recorded.


RESULTS
There was no mortality in both groups. There were no differences in the demographic characteristics or clinical presentations between the two groups. Compared with the T-tube group, the operative time and postoperative stay were significantly shorter and the incidences of overall postoperative complications and biliary complications were statistically and significantly lower in the primary closure group.


CONCLUSIONS
Laparoscopic common bile duct exploration with primary closure without external drainage after laparoscopic choledochotomy is feasible, safe, and cost-effective. After verification of ductal clearance, the CBD could be closed primarily without T-tube insertion.
Gastroenterology Surgical Center, Mansoura University, Mansoura, Egypt.
Ahmed Abdel-Raouf
AA
El-Geidie
D000328:Adult; D000368:Aged; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D042883:Choledocholithiasis / Q000175:diagnosis / Q000601:surgery*; D003135:Common Bile Duct / Q000601:surgery; D004322:Drainage / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007813:Laparotomy / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D011336:Probability; D011446:Prospective Studies; D012086:Reoperation; D018570:Risk Assessment; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult