PRIMARY COMMON BILE-DUCT CLOSURE FOLLOWING EXPLORATION - AN EFFECTIVEALTERNATIVE TO ROUTINE BILIARY DRAINAGE

Primary closure of the common bile duct following exploration has been safely and effectively performed, as advocated by Halsted, provided n o evidence of pancreatitis, cholangitis, or ampullary obstruction exis ts. Using this precedent, the operative management and clinical course of 29 patients undergoing common bile duct exploration (CBDE) for cho ledocholithiasis from 1986 to 1992 were reviewed. Ten patients had pri mary closure of the common bile duct (CBD) following choledochotomy an d exploration, and 17 patients had t-tube placement. Two patients had CBDE through an enlarged cystic duct that was then ligated. Patients w ere selected for t-tube placement if they had pancreatitis, ascending cholangitis, evidence of retained stones, or ampullary obstruction. Tw o patients in this series died. No patient with primary closure of the CBD suffered a biliary complication including retained stones, biliar y fistula, pancreatitis, or bile peritonitis. Serious systemic complic ations were comparable in both groups. The results of this series supp ort the safety of primary common bile duct closure in selected cases.