Comparative Study of Primary Closure Versus T-Tube Drainage Following Common Bile Duct Exploration in Patients with Choledocholithiasis

Abstract

Background:Choledocholithiasis is a common biliary disorder that frequently requires common bile duct (CBD) exploration when endoscopic management is unsuccessful or unavailable. Traditionally, T-tube drainage has been employed following CBD exploration to facilitate biliary decompression and postoperative cholangiography. However, primary closure of the CBD has emerged as an alternative approach that may reduce postoperative morbidity, shorten hospital stay, and improve patient comfort. This study compares the outcomes of primary closure and T-tube drainage following CBD exploration in patients with choledocholithiasis.
Objectives: To compare the safety and efficacy of primary closure versus T-tube drainage following common bile duct exploration in patients with choledocholithiasis, with respect to postoperative complications, biliary leakage, operative time, duration of hospital stay, and overall patient outcomes.
Materials and Methods: A comparative study was conducted on patients diagnosed with choledocholithiasis who underwent common bile duct exploration. Patients were allocated into two groups: Group A underwent primary closure of the CBD, while Group B underwent T-tube drainage after exploration. Demographic characteristics, operative findings, postoperative complications, duration of hospital stay, biliary leakage, wound infection, and need for re-intervention were recorded and analyzed using appropriate statistical methods. A p-value of <0.05 was considered statistically significant.
Results: Both techniques achieved successful ductal clearance. The primary closure group demonstrated a significantly shorter postoperative hospital stay and earlier recovery compared with the T-tube drainage group. The incidence of postoperative biliary leakage and other complications was comparable between the two groups, with no significant difference in retained stones or mortality. Overall, primary closure was associated with improved postoperative recovery and reduced morbidity without compromising patient safety.
Conclusion: Primary closure following common bile duct exploration is a safe and effective alternative to T-tube drainage in selected patients with choledocholithiasis. It offers the advantages of reduced hospital stay, faster postoperative recovery, and avoidance of T-tube-related complications while maintaining comparable surgical outcomes. Careful patient selection and meticulous surgical technique are essential for achieving optimal results.