Primary closure versus T-tube drainage after laparoscopic choledocholithotomy: a prospective randomized study

Authors

  • Jugendra Pal Singh Shakya Department of Surgery, S.N. Medical College, Agra, Uttar Pradesh, India
  • Neelabh Agrawal Department of Surgery, S.N. Medical College, Agra, Uttar Pradesh, India
  • Arun Kumar Department of Surgery, S.N. Medical College, Agra, Uttar Pradesh, India
  • Archana Agrawal Department of Anaesthesia, HIMS, Uttar Pradesh, India
  • Akash Singh Department of Surgery, S.N. Medical College, Agra, Uttar Pradesh, India
  • Kunwar Vishal Singh Department of Surgery, S.N. Medical College, Agra, Uttar Pradesh, India
  • Charu Yadav Department of Surgery, S.N. Medical College, Agra, Uttar Pradesh, India

DOI:

https://doi.org/10.18203/2349-2902.isj20171635

Keywords:

Choledocholithotomy, Laparoscopic, Morbidity, Primary closure, T-tube

Abstract

Background: Traditionally laparoscopic common bile duct exploration is followed by T-tube placement because of which patients suffer problems related to T-tube thereby increasing the morbidity of patients. Primary closure of CBD following laparoscopic choledocholithotomy is now being considered as an alternative superior to the traditional method. This study is designed to analyse the outcome of primary CBD repair in terms of mean operation time, duration of hospital stay and post-operative morbidity.

Methods: A prospective randomized study was done in which 40 patients at our institute and associated hospitals were divided into two groups to compare the results of primary closure to T-tube placement following laparoscopic choledocholithotomy.

Results: 40 patients were included in this study. The mean operating time was observed to be 65±14.05 mins in Group A (primary closure) patients while that in case of Group B (T-tube drainage) patients was 95.25±9.66 mins with a p-value 0.0001 which is considered statistically significant. The average duration of hospital stay in Group A (primary closure) was 8.2 days which was much shorter than that of Group B (T-tube drainage) patients which was of 15.7 days. The post-operative complication was observed in 1 patient of Group A (primary closure) while post-operative complication occurred in 3 patients of Group B (T-tube drainage).

Conclusions: This study indicates that primary repair following laparoscopic choledocholithotomy is a safer and more effective method than T-tube drainage and we strongly recommend this procedure in clinical practice.

References

DeVita, Lawrence VT, Theodore S. Preface. In: DeVita, Lawrence VT, Theodore S, eds. Principles and Practice of Oncology. 8th ed. US: CBSPD; 2008.

Mohandas KM. Colorectal cancer in India: controversies, enigmas and primary prevention. Indian J Gastroenterol. 2011;30(1):3-6.

Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010;127:2893-917.

Wolff BG, Fleshman JW. Colorectal cancer: epidemiology, etiology and molecular basis. In: Wolff BG, Fleshman JW, eds. The ASCRS Textbook of Colon and Rectal Surgery. 2nd ed. New York, NY: Springer; 2007.

Myers JA, Millikan KW, Saclarides TJ. Colon cancer. In: Myers JA, Millikan KW, Saclarides TJ, eds. Common Surgical Diseases. 2nd ed. New York, NY: Springer; 2008:173.

Mulvihill SJ, Pass H, Thompson RW. Colon rectum and anus. In: Mulvihill SJ, Pass H, Thompson RW, eds. A Book. 1st ed. New York: Springer; 2001:701.

Pathy S, Lambert R, Sauvaget C, Sankaranarayanan R. The incidence and survival rates of colorectal cancer in India remain low compared with rising rates in East Asia. Dis Colon Rectum. 2012;55(8):900-6.

DeVita, Lawrence VT, Theodore S. Colon cancer. In: DeVita, Lawrence VT, Theodore S, eds. Principles and Practice of Oncology. 8th ed. US: CBSPD; 2008:1234.

DeVita, Lawrence VT, Theodore S. Preface. In: DeVita, Lawrence VT, Theodore S, eds. Principles and Practice of Oncology. 8th ed. US: CBSPD; 2008.

Tjandra JJ, Clunie GJA, Kaye AH, Smith JA. Colorectal cancer. In: Tjandra JJ, Clunie GJA, Kaye AH, Smith JA, eds. 3rd ed. US: Textbook of Surgery. US: Wiley-Blackwell; 2006:191.

Doherty GM. Large intestine. In: Doherty GM, eds. CSDT. 13th ed. New York: McGraw-Hill Medical; 2010: Chapter 30.

Weerakkody Yuranga, Gaillard Frank. Colorectal carcinoma, 2014. Available at: www.radiopaedia.org. Accessed 13 September 2014.

Moqhimi-Dehkordi B, Safee A. An overview of colorectal cancer survival rates and prognosis in Asia. World J Gastrointest Oncol. 2012;4(4):71-5.

William R. Wrightson. Colon and rectal cancer. In: William R. Wrightson, eds. Current Concepts in General Surgery. 1st ed. US: CRC Press; 2006: 114.

Zinner M Jr, Ashley S. Colorectal cancer. In: Zinner M Jr, Ashley S, eds. Maingot’s, Perspective on Colonic Neoplasm. 12th ed. New York: McGraw-Hill Education; 2013: 795.

Zinner M Jr, Ashley S. Colorectal cancer. In: Zinner M Jr, Ashley S, eds. Maingot’s, Perspective on Colonic Neoplasm. 12th ed. New York: McGraw-Hill Education; 2013: 796.

Dukes CE. Cancer of rectum an analysis of 1000 cases. J Path Bact. 1940;50:527.

Downloads

Published

2017-04-22

Issue

Section

Original Research Articles