A Prospective Study of Complications of T- Tube Drainage of Common Bile Duct in The Management of Choledocholithiasis in JLNMCH, Bhagalpur, Bihar

摘要

Background: Surgery for more than 100 years has been the standard mode of care for the treatment of diseasesof the biliary tract. Cholecystostomy was the initial surgical treatment for gallstones. The rationale for use of T-tube is that it minimises the risk of leakage in the early postoperative period if there is persistent distal duct obstruction. It also allows further radiological examination and may facilitate removal of residual calculi. Material and Methods: The study was a prospective study undertaken in the Department ofSurgery, Jawaharlal Nehru Medical College& Hospital, Bhagalpur, Bihar from November 2013 to October 2014. This study included 40 patients, who were subjected to open choledochotomy with T-tube drainage and aspiration of bile from common bile duct for culture. Postoperatively, the T-tube bile culture was taken on 5th postoperative day for culture sensitivity and all the patients were observed for the development of complications associated with the T-tube drainage of common bile duct and complications following T-tube removal. Results: (i)Choledocholithiasis was more common in females than males. (ii)Age range of our patients was 22-67 years with mean age(± standard deviation) of 46.75 (± 8.63) years.(iii)Abdominal pain was the most common presenting symptom followed by fatty dyspepsia.(iv)Bactibilia was observed on bile culture in 25 patients (62.5%) with aerobes isolated in 23 (92%) out of 25 culture positive patients and anaerobes isolated in 5 patients (20%). Among the patients with positive bile culture, 2 patients were those who had previous ERCP.(v)E. coli was the most common organism isolated in 12 (48%) patients,followed by Enterococcus in 5 (20%) patients. Anaerobes mixed with aerobes were culture in 3 patients (12%).(vi)T-tube bile culture taken on 5th postoperative day showed increased incidence of bactibilia.(vii)Complication rate of T-tube drainage of CBD in our study was 25%.(viii)Most common complication was pain abdomen (10%), followed by wound infection and vomiting, 5% each.(ix)Complications of T-tube drainage of CBD were seen more commonly in patients having positive bile culture (32.14%) than bile culture negative patients (8.33%). Conclusion: Persons with stones in the biliary tract harbour bacteria in bile.T-tube drainage of CBD carriesrisk of bactibilia.ERCP can result in increased incidence of long-term bactibilia.Patients with bactibilia are at high risk for development of complications associated with T-tube drainage of CBD.Cholangiogram is mandatory before removal of T-tube.Patients should be observed in hospital after T-tube removal for over a day.Majority of patients developing complications following T-tube removal can be managed conservatively.