Comparison of Clinical Characteristics between Primary Closure of Common Bile Duct and T-tube Drainage after Choledochotomy / 한국간담췌외과학회지

ABSTRACT

BACKGROUND/AIMS: In the management of choledocholithiasis, T-tube drainage was the most common treatment modality after common bile duct (CBD) exploration. However, the T-tube drainage has several problems and risk of complications such as abdominal discomfort, long duration of drainage, or bile leakage. We evaluated the effectiveness of primary closure of CBD after choledochotomy and the possibility of substitution for T-tube drainage. METHODS: Seventy six patients with choledocholithiasis who had undergone CBD exploration were enrolled in this study from January 1999 to March 2001. 20 patients among them had undergone primary closure of CBD with preoperative endoscopic nasobiliary drainage (ENBD) or percutaneous transhepatic biliary drainage (PTBD) in situ after exploration (primary closure group), 56 patients had undergone T-tube drainage (T-tube group). We compared the clinical characteristics and outcome between two groups. RESULTS: There was no difference in postoperative complication (19.6% vs. 20%), the mean amount of biliary drainage (326 ml/day vs. 320 ml/day) and the duration of hospitalization (11.6 day vs. 9.2 days) between the both groups. The duration of biliary drainage was significantly longer in the T-tube group (45.3 days) than in the primary closure group (9.2 days; p<0.01). The rate of remnant stone was higher in the T-tube group (32.1%) than the primary closure group (20%), there was not statistically significant. CONCLUSION: The primary closure of CBD with the preoperative biliary drainage was relatively safe and resulted in no difference of clinical outcome. Furthermore, this method induced going back early to normal life. These result suggest that the primary closure of CBD may be a feasible technique after choledochotomy when the patients are selected by specialized indications.