A Comparative Study of Primary Common Bile Duct Closure vs T-Tube Drainage After Open Common Bile Duct Exploration At TMMC&RC Moradabad

Primary Common Bile Duct Closure vs T-Tube Drainage After Open Common Bile Duct Exploration

Abstract

Background: There are two ways for extracting the common bile duct stones which includes Endoscopic retrograde cholangiopancreatography and a surgical method through the laparoscopic or open method. The placing of T - tube is associated with having a prolonged length of hospital stay that is always more than 10 days. Also there has been a less incidence of the recurrent stones that got reported in terms with the primary closure of the CBD while it gets compared with the drainage of the T - tube. This study was a comparative study carried out in the patients of Uttar Pradesh in regards to the primary common bile duct closure versus the T - tube drainage after there is the exploration of the common bile duct. Subjects and Methods: Inclusion Criteria are Age more than 18 years, Patients with large CBD stones presenting with symptoms of obstructive jaundice who have either had failed ERCP, or have refused ERCP, Large and impacted stones. Exclusion Criteria are pancreatic pathology, Recurrent CBD stones, Renal failure, Malignancy, alll the cases declared unfit by the anesthesiologist for the surgery. Results: The majority of the cases were female which accounts for 84.1% and only 15.9% of them were male. Majority of the cases suffered from a severe pain in their abdomen which accounted for 63.6%, 31.8% of clinical jaundice and only 4.5%  experienced fever  with the pain abdomen. 81.8% got diagnosed with choledocholithiasis and only 18.2% of them were found to have cholelithiasis along with choledocholithiasis. After the 14th day the representation of the distribution of frequency in accordance with the T tube cholangiogram showed that the result was positive in 50% and negative in 50%. None of the patients had any retained stones in them and 90.9% of the cases did not face any T- tube site infection post the treatment and only 4 of the patients had faced the infection in T- tube site. The Bile leak post the removal of T tube which was done after 3 days shows that the majority of the cases did not report any incidence of bile leak that accounted for 88.6% and only 5 subjects had experienced bile leak. Conclusion: Primary common bile duct closure can be considered to be a safer and much more effective way for managing the open common bile duct exploration in regards to the common bile duct stones.