Primary Closure of the Duct Following Common Bile Duct Exploration in Choledocholithiasis-A Comparison between T-tube Drainage and RTBD-tube Drainage

Retrograde transheptic biliary drainage (RTBD) and primary closure of the common bile duct (CBD), as a new method of treatment for choledocholithiasis, was compared retrospectively to conventional T-tube drainage as a control, in terms of postoperative major complications which necessitate laparotomy. We also evaluated radiographic diametric change in CBD at the site of primary closure and changes in liver function tests after this procedure. Between April 1986 and July 1991, a total 132 cases were managed by this procedure and compared with 199 cases of conventional T-tube drainage. In the RTBD group, only one (0.8%) postoperative major complication was seen due to incomplete fistula formation, while eight (4%) major complications were seen in the control group. Cholangiography via the RTBD tube revealed no severe stenosis at the site of primary closure. Liver function tests returned to normal levels immediately after the RTBD procedure. From these data we conclude that RTBD and primary closure of the CBD may be a clinically safe, alternative procedure for choledocholithiasis.