Clinical Consideration of Choledocholithiasis Treatment: Analysis of Primary Closure versus T-tube Drainage after Choledochotomy.
- Author:
Gum Oh CHUNG
1
;
Jung Nam KWON
;
Dong Eun PACK
;
Byung Sun SO
;
Kwon Mook CHAE
Author Information
1. Department of Surgery, Wonkwang University Medical Center, Iri, Korea. chaekm@wmc.wonkwang.ac.kr
- Publication Type:Original Article
- Keywords:
Primary closure;
Choledochotomy
- MeSH:
Bacteremia;
Bile;
Choledocholithiasis*;
Common Bile Duct;
Drainage*;
Humans;
Incidence;
Length of Stay;
Medical Records;
Multiple Organ Failure;
Peritonitis
- From:Journal of the Korean Surgical Society
2003;65(1):55-60
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: The placement of a drainage tube in the common bile duct, following a choledochotomy, has become accepted as routine procedure since it was first reported, by Abbe, in 1892. However, many complications are associated with T-tube drainage, such as bile peritonitis after its removal, accidental dislodgement, bile leakage from the T-tube track and a high incidence of postoperative bacteremia, have been reported. This study was designed to evaluate the primary closure as a suitable surgical technique in placce of T-tube drainage following a choledochotomy METHODS: Between January and December 2002, primary closures were performed in 41 cases and T tube drainage in 112, following a choledochotomy. These cases were divided into 2 groups (group A: primary closure, and group B: T-tube drainage). The medical records of the patients were reviewed, and the following data analysed -age, sex, preoperative laboratory value, intraoperative finding, postoperative laboratory value, complication, and days of postoperative hospital stay. RESULTS: There were no significant differences observed in the data of the investigated parameters, with the exception of the mean post-operative hospital stay. The mean post- operative hospital stays were 11.82 and 18.08 days in groups A and B (P=0.0034), respectively. The complication rates of each group showed no statistical difference. However bile peritonitis or bile leakage after T-tube removal developed 5 cases from group B. There were 2 and 5 deaths due to MODS & ARDS, respectively. CONCLUSION: A primary closure, following a choledochotomy, may be a suitable alternative technique to T-tube drainage under reasonable conditions.
