J Korean Surg Soc.  2009 Dec;77(6):399-403. 10.4174/jkss.2009.77.6.399.

Comparison of Primary Closure and T-tube Drainage following Laparoscopic CBD Exploration

• Noh KT
• Min SK
• Lee HK

• KMID: 1464819
• DOI: http://doi.org/10.4174/jkss.2009.77.6.399

Abstract

PURPOSE
Laparoscopic common bile duct exploration (LCBDE) has traditionally been accompanied by T-tube drainage. However, patients must carry it for several weeks and often suffer problems related to the T-tube. So, primary closure of CBD has been proposed as a safe and effective alternative to T-tube placement after laparoscopic choledochotomy. The aim of this study was to compare primary closure versus T-tube drainage after LCBDE.
METHODS
Between January 2000 and December 2005, 63 patients suffering from choledocholithiasis underwent LCBDE successfully through choledochotomy. Those patients were devided into two groups; primary closure group (group P) and T-tube placement group (group T). Patients' clinical characeristics, postoperative outcome and follow up data were compared between the two groups.
RESULTS
Of 63 patients, 30 (48.6%) had primary closure of the choledochotomy and 33 (52.4%) had T-tube drainage. Stone clearance rate was 100% in both groups. The mean operation time and the incidence of postoperative complications had no significant difference between the two groups. The mean postoperative hospital stay (8.8 vs. 16.4 days, P<0.001) was significantly shorter in the P group compared to the T group. Each group had one recurrent CBD stone. None of both groups showed symptoms or signs associated with CBD stricture during the follow up period.
CONCLUSION
Primary closure of choledochotomy after LCBDE can prevent the disadvantages associated with T-tube and lead to a shorter hospital stay. Therefore, primary closure should be considered as a safe alternative method after LCBDE.

Keyword

Common bile duct stones; Laparoscopic common bile duct exploration; Choledochotomy; Primary closure

MeSH Terms

Choledocholithiasis
Common Bile Duct
Constriction, Pathologic
Drainage
Follow-Up Studies
Humans
Incidence
Length of Stay
Postoperative Complications
Stress, Psychological

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