Study on Primary Closure versus Intraoperative CBD Stenting after Choledocholithotomy

Abstract
Background: This study aimed to compare intraoperative Common Bile Duct (CBD) stenting with Primary Closure (PC) after choledocholithotomy as regard safety, feasibility, post-operative outcome and complications.
Patients and Methods: This study has been done at Assiut University Hospital in General Surgery Department in the period between 1st January 2016 to 30 June 2017 including patients with CBDS and failed extraction of stones by Endo-scopic Retrograde Cholangiopancreatography (ERCP) and candidates for CBD exploration.
Results: The study included 30 patients assigned to 2 groups, Group (A) primary closure and Group (B) intraoper-ative CBD stenting after choledocholithotomy, each group formed of 15 patients. There were no significant differences between two groups as regard the demographic characteristics. In Group (A) abdominal pain was reported in 3 cases vs. 7 cases in Group (B) and acute pancreatitis in no case vs. 2 cases in Group (B) and cholangitis in no case vs. 1 case in Group (B). As regard pre-operative biological character Group (A) was reported leukocytosis in 3 cases vs. 7 cases in Group (B), p=0.021. In Group (A) CBD diameter was 16±3mm vs. 13±2 in Group (B). The operation time was 120±28 in Group (A) vs. 125±20 in Group (B).
About 53% of cases in Group (A) has been done laparo-scopicaly vs. 13% in Group (B). The hospital stay in Group (A) was 4±1.5 vs. 2±0.5 days in Group (B) Six cases of Group (A) experienced bile leakage vs. 2 cases in Group (B). Four cases of Group (A) were reported to have wound infection vs. 2 cases in Group (B).
Conclusion: Intraoperative CBD stenting is a safe and feasible method after choledocholithotomy in cases of CBDS after failure of their extraction by ERCP.