Primary Closure of the Common Duct over Endonasobiliary Drainage Tubes |
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Authors: | Mehmood A Wani MS Nisar A Chowdri MS Sameer H Naqash MS Nazir A Wani MS |
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Institution: | (1) Department of General Surgery, Sheri-Kashmir Institute of Medical Sciences, Soura, Kashmir, India |
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Abstract: | The T-tube remains the standard method of intraductal drainage after open choledochotomy for choledocholithiasis. We studied
the use of an endonasobiliary drainage (ENBD) tube as an alternative to the T-tube for postoperative intraductal drainage.
A series of 20 patients with documented choledocholithiasis in whom endoscopic methods of stone retrieval failed to clear
the common bile duct (CBD) were selected for the study. All patients had ENBD tubes placed preoperatively at endoscopic retrograde
cholangiopancreaticography and then were subjected to open choledocholithotomy with primary closure of the choledochotomy
over the ENBD. The age of the patients in the study group ranged from 18 to 75 years. Three patients (15%) had acute cholangitis
at the time of surgery. Stones were confirmed at surgery in 85% of the patients, and the size of the CBD was found to range
from 1.0 to 2.3 cm. All 20 patients underwent closure of the common duct over an ENBD tube without any difficulty. None of
the patients experienced biliary complications such as bile leaks, biliary peritonitis, biliary fistula, pancreatitis, or
cholangitis. No patient had any residual stone as documented by postoperative cholangiograms. Abdominal drains remained in
place for 2 to 4 days, and the ENBD tubes were removed between days 6 and 8. The length of the postoperative hospital stay
varied from 7 to 15 days, with 65% of the patients going home before postoperative day 8. |
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