Common bile duct repair after exploration with versus without T-tube: a prospective randomized comparative study

Background In common bile duct (CBD) exploration, closure of the bile duct on a T-tube (TT) was the standard technique for decades. Owing to its adverse effects and the new minimal invasive modalities in confirmation of CBD clearance, the theory of primary repair was raised strongly. However, the safety of the patients makes the debate still present between TT and primary repair. Patients and methods The study enrolled two groups of patients (35 patients in each group): group 1 for primary repair of CBD and group 2 for TT based repair. Operative time, postoperative hospital stay, and biliary complications were compared between the two groups. Results In this study, it was found that patients who underwent primary closure (PC) had significantly lower operative time (111.04 +/- 5.55 vs. 121.15 +/- 6.11 min; P<0.001). TT repair group had significantly shorter hospital stay (8.56 +/- 2.01 vs. 2.50 +/- 0.50 days; P<0.001) in comparison to those who underwent PC of CBD. Both groups had insignificant differences regarding intraoperative blood loss (P=0.15). These reported complications showed no significant differences between both groups (P>0.05). The overall complications rate was four (11.4%) and five (14.3%) patients in PC and TT groups, respectively. Conclusions Each case with CBD exploration should be individualized regarding methods of closure either TT insertion or PC based on the experience of the surgeon and availability of equipment.