It has been accepted practice to place a drainage tube in the common bile duct following choledochotomy. But some authors believe that routine intraductal drainage of common bile duct following choledochotomy is unnecessary and may even increase
the
hazard of the operation to the patient. Many complications associated with T-tube catheter drainage have been reported; bile peritonitis after T-tube removal or accidental dislodgement, bile leakags from T-tube tract, higher incidence of
post-operative
bacteremia, irritant foreign-body reaction of a tube in the common bile duct, secondary hemorrhage-from common bile duct, and catheter broken off within the duct.
Clearly there is still much controversy on the question of whether or not to drain the common bile duct by intraductal drain after choledochotomy. We performed a prospective study to compare the results of the primary closure(group A. N=30) and
that of
T-tube drainage(Group B, N=49). The complication rate of the group B(39%) was hither than group A(20%)(P=0.07). Especially. The incidence of wound infection, bile leakage, and respiratory complication were more common in group B. The mean
post-operative
stay in hospital of group A(13.3 days) was significantly shorter than group B(195 days)(P<0.05). Even if the complicated cases of both group were excluded, the post-operative stay in hospital of group A(11.5 days) was 6 days shorter than Group
B(17.3
days). Liver function of both groups showed abnormality during preoperative period, but both of them normalized usually at 6th postoperative day.
There results show that primary closure is as safe as intraductal drainage of common duct if the cases are properly selected. We believe that in recent years more surgeons are closing the common bile duct without intraductal drainage. It is the
primary
object of this paper to encourage this trend.
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