Primary Common Bile Duct Closure

Abstract

To show that primary closure of the common bile duct following minicholecystectomy is safe and effective.Design: Eighty-nine primary common bile duct closures done over 13 years.Setting: General community hospital.Patients: Patients with cholangiographic evidence of stones in the common bile duct.Interventions: Minicholecystectomy followed by a primary common bile duct closure or common bile duct closure over a T tube.Main Outcome Measures: Successful clinical result of primary common bile duct closure following minicholecystectomy.Results: Eighty-nine primary closures of the common bile duct between 1983 and 1986, resulting in successful clinical outcomes. Conclusion:Primary closure of the common bile duct followingminicholecystectomyissafe,effective,andinexpensive.

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

“…This is in contradiction to the practice of other surgeons who discharge patients along with tubes or drains [20] and follow them with cholangiograms in the out patient department. Our patients are usually illiterate, from distant areas with poor sanitation and limited medical resources.…”

“…However, they reported 13 patients of the 37 who had undergone primary closure to drain bile through the wound drain for a median of 5 days (2-7 days). Seale and colleagues on average discharged patients 3.6 (0-7) days after primary closure of the CBD following choledochotomy [20]. However, patients in his study were discharged home along with their drains which were removed 3 to 10 days postinsertion.…”

“…To avoid the complications of T tubes and reduce hospital stay many surgeons perform primary closure without T tubes with appreciable success [16,[18][19][20]. However there is still a risk of bile leak and postoperative cholangiography cannot be performed.…”

“…Many authors have successfully promoted primary closure of the common bile duct (CBD) without intraductal drainage with no significant serious morbidity [12][13][14][15][16][17][18][19][20][21] Others have used alternative methods but maintained the principle of biliary drainage by using retrograde transhepatic biliary drainage (RTBD) [22][23][24] or transcystic tube drainage(C tube) [22] We have previously reported the advantages of the use of endonasobiliary (ENBD) tubes as a means of postoperative CBD drainage [25] and this technique has also been subsequently applied to laparoscopic Choledocholithotomy [26]. In the present study we compared the results of intraductal drainage through ENBD tubes with the standard T tube, a comparison which has not been reported in literature.…”

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.…”