Primary suture vs. T-tube after common bile duct exploration (our 25 years of experience).

Purpose: The aim of our retrospective study is to return confidence in primary suture (PS) procedure after common bile duct exploration (CBDE). The first CBDE was performed in 1884 using PS. T-tube drainage was introduced 10 years later, and PS procedure has been abandoned today.

Material And Methods: In the course of the last 25 years (1974-1999 period) 4971 cholecystectomy have been performed with 682 (13.5%) CBDEs. There have been 201 (30%) T-tubes, 238 (34%) PS, 219 (32%) biliodigestive anastomosis (BDA) and only 24 (3%) papillotomies (PT) performed. Intraoperative choledochoscopy has been performed as a routine intraoperative method, too.

Results: In 439 patients, operated either using PS or T tube procedure were as follows: retained stones 6:16 (2.5%:8%), billiary complications 4:14 (1.6%:7%) and mortality 1:6 (0.3%:3%), respectively. PS is a significantly less expensive procedure, spending less medicaments, i.v. fluids, X-ray and laboratory tests, with a shorter postoperative hospital stay.

Conclusion: PS is unjustly abandoned operative procedure. The advantages of the method are lower complications rate as well as lower costs. Present progress in surgery, less operative aggression, must be considered, especially during laparoscopic cholecystectomy.