Primary closure versus T-tube drainage after open choledochotomy.

BACKGROUND: Choledochotomy followed by T-tube has long been a standard surgical treatment for choledocholithiasis. It is still a preferred choice in many hospitals where minimal invasive procedures are not feasible. The use of T-tube is not without complications. To avoid the complications associated with T-tube, we have performed primary closure of the common bile duct (CBD) after exploration. This pilot study assesses the safety of primary closure of CBD, which would help form a basis for implementation on a wider scale. OBJECTIVE: To compare the clinical results of primary closure with T-tube drainage after open choledochotomy and assess the safety of primary closure for future application on a greater mass. PATIENTS AND METHODS: This comparative study was conducted at surgical unit IV Liaquat University of Medical and Health Sciences, Jamshoro, from January 2007 to December 2007. Thirty-five patients were included in the study of which 16 patients underwent primary closure. RESULTS: Thirty-five patients were included in the study. The mean age of patients who had primary closure done (n = 16) was 46.0 +/-16.8 and there were two (12.5%) males and 14 (87.5%) females. After primary closure of the CBD, bile leakage was noted in one patient (6.3%), which subsided without any biliary peritonitis as compared to the T-tube group in which two patients (10.5%) had bile leakage. Postoperative jaundice was seen in one patient (5.3%) who had a T-tube because of a blockage of CBD. Not a single patient had a retained stone in both groups as well as no recurrence of CBD stones. The postoperative hospital stay after primary closure was 5.56 +/-1.1 days as compared to after T-tube drainage which was 13.6 +/-2.3 days. The total cost of treatment in patients who underwent primary closure was USD194.5 +/-41.5 but after T-tube drainage it was USD548.6 +/-88.5. The median follow up duration for both groups was 6 months. CONCLUSION: Primary CBD closure is a safe and cost effective alternative to routine T-tube drainage after open choledochotomy.

Deep vein thrombosis at King Abdul Aziz University Hospital.

OBJECTIVE: To study the incidence of deep vein thrombosis and pulmonary embolism at King Abdul Aziz University Hospital. To determine the risk factors, use of different diagnostic modalities, treatment given and to compare our findings with those reported in the literature. METHODS: Retrospective study which included all cases of deep vein thrombosis and pulmonary embolism admitted to the medical ward of King Abdul Aziz University Hospital during the period between January 1994 till March 1999 were analyzed. RESULTS: Total of 75 patients were diagnosed to have deep vein thrombosis with mean age of 44.16 +/- 14.5 years and male:female ratio of 1:2. Doppler ultrasound was used for the diagnosis in 56 of 75 patients (75%). Pulmonary embolism as a complication of deep vein thrombosis developed in 24 of 75 patients (32%). Prolonged immobilization was found to be the most common risk factor 17 of 75 (23%). All the patients were treated with conventional heparin followed by warfarin. CONCLUSION: As discussed, our results are comparable with those reported in the literature. Post operative patients who are anticipated to have prolonged immobilization should receive prophylactic anti coagulation with subcutaneous heparin. Thrombophillia screening should be reserved for those with recurrent deep vein thrombosis or patients with positive family history.