LAPAROSCOPIC EXPLORATION OF COMMON BILE DUCT WITH PRIMARY CLOSURE VERSUS T-TUBE DRAINAGE

Background: Laparoscopic exploration of the common bile duct followed by T-tube has long been a standard surgical treatment for choledocholithiasis. However the use of T-tube is not without complications. To avoid these complications we have performed primary closure of the common bile duct (CBD) after laparoscopic exploration.

Objective: To assess the benefits and harms of T-tube drainage versus primary closure after laparoscopic common bile duct exploration.

Material and methods:This is a comparative study carried out at General Surgical Deptt of Hayatabad Medical Complex Peshawar Pakistan from 6-6-2019 to 6-6-2021. Total 34 patients for laparoscopic exploration of the common bile duct were included in the study. 

Results:The length of mean postoperative hospital stay was muchshorteringroupA(4.5 ± 1.4) thaningroupB(7.2 ± 1.6).Thehospitalization expenses were statistically lower in group A (15150.0 ± 2160.5) than in group B (19798.1 ± 2485.5). No significant difference was observed in the operating time in both groups i.e. (128.3 ± 25.9) in group A & (133.9 ± 26.7). Intraoperative blood loss were also shows no significant difference amongst both groups, (101.3 ± 56.1) in group A & (103.9 ± 60.2).

Bile leakage rate in group A is 2(5.8%) and in group B 3(8.8%), intraabdominal bleeding 1(2.9%) & 1(2.9%), pulmonaryinfection were 2(5.8%) & 1(2.9%), intra-abdominal infection were 2(5.8%) & 3(8.8%), gastroduodenal serosal injury 0 (0%) & 0 (0%), wound infection 1 (2.9%) & 1 (2.9%), stone recurrence 2(5.8%) & 2(5.8%) and bile stricture seen in 0 (0%) in group A & 1 (2.9%) in group B respectively. Table II

Conclusion:Primary closure of the CBD is a safe and cost effective alternative to routine T-tube drainageafter Laparoscopic exploration.