Primary Closure of Common Bile Duct Over Infant Feeding Tube as a Stent Following Choledochotomy: A Variation In Technique

Introduction:Even with the emergence of laparoscopic common bile duct exploration, open common bile duct exploration remains the procedure of choice for the surgical management of choledocholithiasis in developing countries. Open CBD exploration is usually followed by a T-tube insertion whichhas been proven to be safe and effective for post-operative biliary decompression. However, the use of T-tube is not without its complications including post-operative bile leak, bile leak following removal, biliary strictureand tract infection among others. Primary closure of the common bile duct although proven superior to T-tube insertion has not gained popularity due to absence of post-operative biliary decompression. We present primary closure of common bile duct over an infant feeding tube as a stent as an alternative to both T-tube insertion and primary closure of common bile duct. Materials and Methods:We present a retrospective analysis of 35 operated cases of choledocholithiasis in whom choledochotomy followed by primary closure of CBD over an infant feeding tube as a stent for post-operative biliary decompression was done. Results:We encountered only a single complication in the form of biliary leak in 3(8.57%) patients which was managed conservatively. In addition to the low complication rates the patients had a short post-operative stay (mean 5.11 days) in the hospital. The infant feeding tube was passed spontaneously in the faeces in the majority of the patients with only 5(14.28%) requiring postoperative endoscopic removal. Conclusion:Thus, primary closure of CBD following choledochotomy over an infant feeding tube as a stent is a safe alternative to T-tube biliary decompression with a significantly low post-operative stay and an acceptably low complication rate.