Complications of supraduodenal choledochotomy: A comparison of three methods of management

Abstract

The complications of elective choledochotomy in a prospective study of 116 patients with suspected intraduct calculi are reported. Management included T tube drainage (n = 59), primary closure of the bile duct (n = 29) and choledochoduodenostomy (n = 28). Septicaemia occurred in 12 patients (10%), with 1 death, and was unrelated to the type of operation. Thirty patients (26%) developed wound infection; this complication was more common after T tube drainage than the other procedures. Intra-abdominal abscess occurred in 3 patients only. Thrombo-embolism was recorded in 10 patients (9%), 7 of whom had an intraduct drain. Postoperative pancreatitis occurred in 5 patients (4%), with 2 deaths; a third of the patients in whom sphincteroplasty had been combined with supraduodenal choledochotomy developed this complication. Reoperation for stones was required in 3 patients with T tube; 3 patients developed a temporary biliary fistula after choledochoduodenostomy. The hospital stay was 9-5 days after primary closure, 14-0 days after choledochoduodenostomy and 16-8 days after T tube drainage. Wound sepsis (32%) and thrombo-embolism (12%) were more common in patients with bacterbilia than in patients where the bile was sterile at operation (13 and 3% respectively). Furthermore, wound sepsis, septicaemia and thrombo-embolism were reduced in patients who were given effective antibiotic cover.

Closure of the Common Duct -Endonasobiliary Drainage Tubes vs. T Tube: A Comparative Study

“…However, complications were found to be less in the ENBD group (Table 2) infection in the T tube group was twice that noted in the ENBD group. Greater incidence of infective complications have been noted to be associated with the use of T tubes in previous studies also [5]. In our study the ENBD was removed 6.515±0.905 days post insertion which is almost 5 days earlier than the T tube (11.727±1.536).…”

“…Complications are known to be associated with the use of T tubes. These may be displacement, biliary sepsis, thromboembolism, electrolyte and fluid losses, wound infections, pancreatitis and obstructive jaundice [1][2][3][4][5][6]. Biliary leaks have been shown to occur at the time of tube removal or at cholangiography [8] which may progress to intraperitoneal collections, external fistulae or even peritonitis [9][10][11].…”

“…It allows a post operative cholangiography and forms a route for the management of residual stones. The T tube is however associated with possible complications which may at times be serious, besides prolonging the hospital stay [4][5][6][7][8][9][10][11].…”

Choledocholithiasis; Frequency of Choleducholethiasis and Evaluation of Primary Closure of Common Bile Duct After Open Exploration as a Treatment Modality in Its Management

“…15 However studies [16][17][18][19][20][21][22] are available in literature that now favor choleduchotomy and primary choledochorrhaphy instead of conventional T tube placement method in order avoid its associated complications. Our study showed no major morbidity and no mortility after primary repair of common bile duct after supraduodenal choledochotomy followed by its closure without placement of T tube.…”

Primary closure after common bile duct exploration versus T-tube drainage: a prospective randomized study and review of literature

“…10,11 Others found higher morbidity in terms of more biliary infection, discomfort from tube, delayed hospital discharge. [12][13][14][15][16][17][18] This study was designed to assess the outcome of primary repair of CBD in terms of operating time, duration of hospital stay and postoperative complications.…”