الفهرس 
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Abstract
The incidence of CBD stone develops in about 10–15% of patients with gall bladder stones and encountered in approximately 7–15% of patients undergoing cholecystectomy.
It is common to be treated by endoscopic retrograde cholangiopancreaticography (ERCP) with endoscopic sphincterotomy (EST), however in cases who has large or multiple CBD stones it can take considerable time for duct clearance.
Therefore, we do not hesitate to use surgical procedures when necessary(4) .Primary closure method or T-tube drainage will be chosen when endoscopic techniques failed to remove them.
Installing T-tube leaves debate in the sense that it causes bile peritonitis before and after the removal of tube, discomfort and prolonged out-patient care, although prolongation operation time, mostly in putting up the T-tube and closing the incision wound securely.
Consequently, this study was conducted and aimed to evaluate of the outcomes of primary closure after open common bile duct exploration for removal of common bile duct stones and assessment of the safety of primary closure.
This descriptive prospective randomized clinical controlled trial was conducted at Hepatobiliary Pancreatic Department (HBP) - Faculty of Medicine – Ain Shams University from January 2022 until March 2023.
We applied our study on 30 patients with CBD stones; with the same inclusion and exclusion criteria. Operative time, risk of bile leakage, expecting hospital stay, stricture along 6 months follow up were assessed.
To the best of our knowledge, there are few studies in literature assessing our study outcomes and most of studies that disagreed with our results were due to several causes as different study methodology, outcomes, sample size and different medical conditions of studied cases at time of enrollment.
As regard total and direct bilirubin levels; our study revealed that there was statistically significant decrease in T and direct bilirubin in follow up ”1st 5 days and post-operative 10th day” compared to preoperative level. The incidence of improvement was better at post-operative 10th day compared with 1st 5 days level.
As regard operative time, it ranged from 1.3 to 3 hours with mean 2.03 and ± SD 0.48 hours.
As regard biliary leakage, 13.3% of the candidates (4 cases) had biliary leakage, two of whom had a pigtail drain insertions a conservative management for 11-13 days. They were discharged uneventful, after clinical improvement of the patients’ follow up laboratory results. On the other hand, the biliary leakage continued in other 2 cases though the pigtail drain was inserted; so the leakage was managed surgically by choledochoduodenostomy.
As regard stricture distribution, in the 6 months follow up; one of the 30 patients developed CBD stricture; for which endoscopic stent therapy was performed.
In conclusion, if no contraindication, primary closure is advised after open common bile duct exploration for removal of common bile duct stones. It is safe, effective and time saving procedure with better postoperative outcomes. The present study can burden the knowledge and shed some light on future prospective comparative studies with larger sample sizes to reassess our findings and conclusion