Title: Comparing Primary Closure with T-tube Drainage in Cases of Choledocholithotomy
Authors: Dr. Sushant Kumar Yadav; MBBS, Dr. Kajal Agrawal; MBBS, Dr. Ayush Kumar, MBBS, Dr Priyank Kumar Sah, MBBS
DOI: https://dx.doi.org/10.18535/jmscr/v13i11.02
Abstract
Background: The optimal method for common bile duct (CBD) closure after choledocholithotomy remains controversial. While T-tube drainage has been traditionally preferred, primary closure is increasingly advocated for selected patients. This study compared the clinical efficacy and safety of primary closure versus T-tube drainage after choledocholithotomy.
Methods: This prospective comparative study included 103 patients who underwent choledocholithotomy between December 2022 and June 2024. Patients were allocated to primary closure (n=44) or T-tube drainage (n=59) groups. Inclusion criteria included age >18 years, confirmed choledocholithiasis, and CBD diameter ≥8mm. Outcome measures included operative parameters (operation time, blood loss, stone clearance rate), recovery parameters (bowel function recovery time, pain scores, hospital stay), complications, and patient satisfaction.
Results: Baseline characteristics were comparable between groups. Primary closure demonstrated significant advantages in operative time. Stone clearance rates were excellent and comparable (96.2% vs 92.6%, p=0.462). Bile leakage was higher in the primary closure group (11.4% vs 1.7%) but all cases resolved conservatively. Stone recurrence (0% vs 6.8%) and incision infections (0% vs 6.8%) occurred only in the T-tube group.
Conclusion: Primary closure after choledocholithotomy offers significant advantages over T-tube drainage in appropriately selected patients, including reduced operative time, faster recovery, decreased pain, shorter hospital stay, and higher patient satisfaction, without compromising stone clearance. Despite higher bile leakage rates, all leaks resolved conservatively. Primary closure should be considered the preferred technique for patients with adequate CBD diameter and complete stone clearance.
Keywords: Choledocholithotomy, primary closure, T-tube drainage, common bile duct stones, bile leakage, enhanced recovery.
References
- vanSonnenberg E, Panchanathan R. Percutaneous Transcholecystic Management of Choledocholithiasis: A Next Horizon for Interventional Radiologists? Radiology. 2019 Jan;290(1):244-245.
- Wandling MW, Hungness ES, Pavey ES, et al. Nationwide assessment of trends in choledocholithiasis management in the United States from 1998 to 2013. JAMA Surg 2016;151(12):1125–1130.
- Lee HM, Min SK, Lee HK. Long-term results of laparoscopic common bile duct exploration by choledochotomy for choledocholithiasis:15-year experience from a single center. Ann Surg Treat Res. 2014; 86: 1–6.
- Ahmed M, Diggory RT. Case-based review: bile peritonitis after T-tube removal. Ann R Coll Surg Engl. 2013; 95: 383-5.
- Daldoul S, Moussi A, Zaouche A. T-tube drainage of the common bile duct choleperitoneum: etiology and management. Journal of visceral surgery. 2012; 149: e172-8.
- Gurusamy KS, Koti R, Davidson BR. T-tube drainage versus primary closure after laparoscopic common bile duct exploration. Cochrane Database Syst Rev. 2013; 2013: CD005641.
- Zhu T, Zhu K, Sun J, Liu C, Lin H, Zhang R. The clinical effect of primary duct closure and T-tube drainage: A propensity score matched study. Asian Journal of Surgery. 2023; 46: 3046-51.
- Zhu T, Lin H, Sun J, Liu C, Zhang R. Primary duct closure versus T-tube drainage after laparoscopic common bile duct exploration: a meta-analysis. J Zhejiang Univ Sci B. 2021; 22: 985-1001.
- Lisotti A, Togliani T, Masciangelo G, Bruni A, Rakichevikj E, Vilmann P, Mirante VG, Fusaroli P. Risk Factors for Common Bile Duct Stones in Patients with Previous Cholecystectomy: A Multicenter Prospective Proof-of-Concept Study. Journal of Clinical Medicine. 2025; 14: 4532.
- IBM Corp. (2020). IBM SPSS Statistics for Windows (Version 21.0) [Computer software]. IBM Corp.
- Zhang Z, Ji H, Chen G, Hou Y. A comparative study of laparoscopic choledocholithotomy with primary suture and T-tube drainage. Medicine (Baltimore). 2024;103: e36757.
- Omar MA, Redwan AA, Alansary MN. Comparative study of three common bile duct closure techniques after choledocholithotomy: safety and efficacy. Langenbecks Arch Surg. 2022; 407: 1805-1815.