Primary Closure of Common Bile Duct: Our Experience

Objective: To assess the outcome of primary closure ofCommon Bile Duct (CBD) after open and laparoscopiccholedocholithotomy.Method: This descriptive observational study was conducted ina private hospital in Chattogram, Bangladesh from February2016 to June 2019. All the patients who underwent open orlaparoscopic choledocholithotomy during the study period wereincluded. Ultrasonographic findings of CBD and its stone,wound infection, operation time, bile leak, biliary peritonitis,hospital stay all were observed.Results: A total of 35 patients were found from clinical recordshaving male to female ratio of 1:1.9. Most of the patients werein 41- 50 years age group. Mean operating time was 135minutes in laparoscopic type and 80 minutes in open type.Overall wound infections were in 5 patients (14.28%) and allwere in open group. Bile leak were in 4 patients (11.42%).Post-operative transient jaundice in 5 patients (14.20%). Biliaryperitonitis in 3 patients (8.57%).Retained single stone in one, pelvic abscess and abortion inone. Mean hospital stay were 5days in open type and 2 days inlaparoscopic type.Conclusion: Primary closure of common bile duct aftercholedocholithotomy is relatively safe and not associated withthat much of complications.

Infection in Minimal Access Surgery and Glutaraldehyde

Background: With increasing use of MAS for various surgicalprocedures, the occurrence of port site infection and port sitetuberculosis is seen more often as postoperative complicationin Bangladesh. Most of the cases present as non-healing portsite wounds. The infection has been attributed to impropersterilization of laparoscopy instruments. There is concern aboutthe effectiveness of the high-level disinfection of reusablelaparoscopic instruments by immersion in 2% glutaraldehyde(GTA).Objective: To evaluate the infection and efficacy ofglutaraldehyde in MAS.Materials and Methods: This is a retrospective, observationalstudy carried out during the period of October 2005 to March2016. Study populations were all the patients underwentvarious minimal access surgical procedures by our team duringthis period. Surgeries were performed by Storz standardlaparoscopy set. All instruments were immersed in 2% GTA for15-20 minutes before each use.Results: Among all the patients (3720), 206 had port siteinfection which is 5.53%. Seventeen cases were diagnosed asport site tuberculosis which is about .45%. Most of them werewithin 30-40 years of age groups. Patients presented with portsite cellulitis, abscess and discharging sinus. All tuberculouscases were confirmed by biopsy. Tuberculous patientsresponded to anti-tubercular therapy. Non- specific infectionsresponded to dressing and antibiotics.Conclusion: Port site infection is common but tuberculosis isnot as common as non- specific infection. Both aretroublesome for the patients and surgeons. Proper sterilizationof instruments is the key. Use of 2% GTA is not cent percenteffective against tuberculosis.