Comparative Study Between Short Term Outcomes of Conventional Open Choledocholithotomy and Choledochoduodenostomy Among the Patients with Multiple CBD Stones At Rajshahi Medical College Hospital

Background: Choledocholithiasis frequently requires open surgical intervention in resource-limited settings, where the comparative effectiveness of choledocholithotomy with T-tube drainage versus choledochoduodenostomy remains controversial. Objective: To compare short-term demographic, operative, biochemical, and postoperative outcomes between conventional open choledocholithotomy with T-tube drainage and open choledochoduodenostomy in patients with multiple common bile duct stones. Methods: This quasi-experimental study was conducted from July 2022 to June 2024 at Rajshahi Medical College Hospital. Sixty patients with multiple choledocholithiasis were enrolled using purposive sampling and divided into two equal groups. Outcomes included operative duration, postoperative liver function parameters, complications, retained stones, and hospital stay. Data were analyzed using SPSS v23 with chi-square and unpaired t-tests. Results: Most patients were aged 30–45 years (90.0% vs. 83.3%), female (56.6% vs. 60.0%), and had normal BMI (73.3% vs. 86.6%) in choledocholithotomy and choledochoduodenostomy groups, respectively. Mean operative time was significantly longer in the choledochoduodenostomy group (124.33 ± 3.59 vs. 103.67 ± 4.99 minutes; p = 0.03). Postoperative hospital stay was significantly shorter following choledochoduodenostomy (7.05 ± 1.78 vs. 13.20 ± 2.11 days; p = 0.03). Elevated alkaline phosphatase (>140 IU/L) was observed in 83.3% versus 63.3% (p = 0.08). Mean serum bilirubin on postoperative day five was comparable (4.51 ± 1.41 vs. 4.31 ± 1.33 mg/dL; p = 0.57). Wound infection occurred less frequently after choledochoduodenostomy (16.7% vs. 26.7%; p = 0.35). Retained stones were significantly lower following choledochoduodenostomy (6.7% vs. 10.0%; p = 0.04), with 3.3% anastomotic leakage. Conclusion: Choledochoduodenostomy offers superior short-term outcomes with reduced hospitalization and retained stones despite longer operative time, supporting its selective use in managing multiple common bile duct stones.