COMPARISON OF POST-OPERATIVE OUTCOME OF LAPAROSCOPIC PRIMARY CLOSURE OF COMMON BILE DUCT VERSUS T-TUBE DRAINAGE FOLLOWING LAPAROSCOPIC CHOLEDOCHOTOMY FOR CHOLEDOCHOLITHIASIS

Samenvatting

Objective:
To compare postoperative outcomes of laparoscopic primary closure of the common bile duct (CBD) versus T-tube drainage following laparoscopic choledochotomy for choledocholithiasis.

Study Design:
Prospective cohort study.

Place and Duration of Study:
Department of General Surgery, Nishtar Hospital Multan, conducted over a period of six months after approval from the Institutional Ethical Review Board.

Methodology:
A total of 228 patients aged 30–60 years diagnosed with choledocholithiasis were enrolled using non-probability consecutive sampling. Patients were allocated into two equal groups of 114 each based on intraoperative decision of the consultant surgeon. Group A underwent laparoscopic choledochotomy followed by primary closure of the CBD using interrupted 3-0 Vicryl sutures. Group B underwent laparoscopic choledochotomy with placement of a 12/14 French T-tube. Postoperative outcomes assessed included hospital stay, bile leakage, and surgical site infection. Patients were followed for three months. Data were analyzed using SPSS version 26. Independent sample t-test was applied for comparison of continuous variables, and Chi-square/Fisher’s exact test was used for categorical variables. A p-value ≤ 0.05 was considered statistically significant.

Results:
The mean hospital stay was significantly shorter in the primary closure group (6.3 ± 1.7 days) compared to the T-tube group (9.5 ± 2.2 days) (p < 0.001). Bile leakage occurred in 6.1% of patients in the primary closure group and 7.9% in the T-tube group (p = 0.61). Surgical site infection was observed in 4.4% of patients in Group A and 7.0% in Group B (p = 0.38). No statistically significant differences were observed in operative time or major postoperative complications between the two groups.

Conclusion:
Laparoscopic primary closure of the common bile duct following choledochotomy is a safe and effective alternative to T-tube drainage. It significantly reduces hospital stay without increasing postoperative complications. Primary closure should be considered the preferred approach in appropriately selected patients.