Management of Choledocholithiasis: Experience from a Tertiary Care Hospital in Bangladesh

Introduction: In our country, choledocholithiasis is still commonly managed by open choledocholithotomy. Traditionally, placement of a T-tube in the common bile duct (CBD) following stone extraction has been practiced to decompress the duct, as intraductal pressure is thought to increase postoperatively. However, recent trends favor primary closure of the CBD without T-tube insertion. Both approaches have advantages and drawbacks, and there remains uncertainty about the optimal method in our setting. The study aims to evaluate and compare outcomes of choledocholithotomy performed with and without T-tube placement. Methods: The study was conducted in the Department of Surgery at Sher-E-Bangla Medical College Hospital, Barishal, over a period from December 2017 to November 2018. It was designed as a descriptive observational study to evaluate the outcomes of the selected patient population. Patients undergoing choledocholithotomy were initially enrolled using convenience sampling based on predefined inclusion criteria. From this pool, 50 patients were randomly selected after applying both inclusion and exclusion criteria. Among them, 25 patients underwent choledocholithotomy with primary closure of the CBD, while the remaining 25 received T-tube drainage. A pre-tested, observation-based, and peer-reviewed data collection tool was developed before the study. Relevant clinical, biochemical, and surgical data were recorded systematically. The collected data were then compiled, edited, and analyzed. Results: A total of 50 patients were included, equally divided between the primary closure group and the T-tube group. The duration of surgery ranged from 60 to 90 minutes. Patients were followed up from 4 months up to 1 year postoperatively. During follow-up, clinical evaluation included assessment for jaundice and features of cholangitis. Additionally, serum bilirubin levels and ultrasonography were performed. Retained stones were identified in one patient in the T-tube group. Conclusion: Both primary closure of the CBD and T-tube drainage following CBD exploration are effective treatment options for uncomplicated choledocholithiasis. Each method is associated with its own set of complications, but overall outcomes are comparable. Medicine Today 2026, Vol.38 (2): 256-260