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Letter to the editor regarding primary closure after laparoscopic common bile duct exploration versus T-tube We read with great interest the article by Dong et al. reporting their experience in primary closure versus closure over a T-tube in patients undergoing common bile duct exploration (CBDE). The authors concluded primary closure of the CBD is safe, effective, and can be performed routinely as an alternative to the use of a T-tube. Specifically, the authors noted that there was no difference in complications, including the stricture rate after primary closure versus closure over a T-tube (0% for both). As the authors point out, the standard traditional technique for closing the bile duct after CBDE is with a T-tube, which, compared with primary closure, theoretically prevents stricture and allows future noninvasive access to the bile duct. However, although quality-of-life studies are largely lacking [1], it is reasonable to assume that several weeks of having a T-tube negatively impacts qualityof-life even in the absence of complications because of the T-tube. Therefore, these and other authors (Supplemental Table) have performed primary closure of the duct after CBDE and have attempted to compare this with traditional T-tube closure after CBDE. We would like to highlight what we believe to be three important points regarding this interesting article. First, we have reservations regarding the conclusion that the rate of complications, such as stricture, is equal between the two groups, given that the median follow-up time for patients was only 12 mo, with some as low as 3 mo. Considering that late stricture after surgical [2] or other [3] trauma to the bile duct is known to occur as much as 10 y later, it seems premature to make conclusions with such short follow-up. It may well be that with 5- or 10-year follow-up either T-tube or primary closure is clearly associated with a higher stricture rate. The overall rate of stricture after CBDE of the studies we reviewed is
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.JournalofSurgicalResearch.com
Letter to the editor regarding primary closure after laparoscopic common bile duct exploration versus T-tube We read with great interest the article by Dong et al. reporting their experience in primary closure versus closure over a T-tube in patients undergoing common bile duct exploration (CBDE). The authors concluded primary closure of the CBD is safe, effective, and can be performed routinely as an alternative to the use of a T-tube. Specifically, the authors noted that there was no difference in complications, including the stricture rate after primary closure versus closure over a T-tube (0% for both). As the authors point out, the standard traditional technique for closing the bile duct after CBDE is with a T-tube, which, compared with primary closure, theoretically prevents stricture and allows future noninvasive access to the bile duct. However, although quality-of-life studies are largely lacking [1], it is reasonable to assume that several weeks of having a T-tube negatively impacts qualityof-life even in the absence of complications because of the T-tube. Therefore, these and other authors (Supplemental Table) have performed primary closure of the duct after CBDE and have attempted to compare this with traditional T-tube closure after CBDE. We would like to highlight what we believe to be three important points regarding this interesting article. First, we have reservations regarding the conclusion that the rate of complications, such as stricture, is equal between the two groups, given that the median follow-up time for patients was only 12 mo, with some as low as 3 mo. Considering that late stricture after surgical [2] or other [3] trauma to the bile duct is known to occur as much as 10 y later, it seems premature to make conclusions with such short follow-up. It may well be that with 5- or 10-year follow-up either T-tube or primary closure is clearly associated with a higher stricture rate. The overall rate of stricture after CBDE of the studies we reviewed is
