T-Tube Use After Laparoscopic Common Bile Duct Exploration

Cuinan Jiang, Xiuhao Zhao, Shi Cheng, Cuinan Jiang, Xiuhao Zhao, Shi Cheng

Abstract

Background and objectives: Laparoscopic common bile duct exploration (LCBDE) has been verified to be an effective technique in treating choledocholithiasis, and T-tube insertion has been widely performed after LCBDE. With growing doubts regarding the effectiveness and safety of T-tube drainage (TTD), it has been suggested to replace such with primary duct closure (PDC). This meta-analysis aimed to evaluate the short- and long-term effectiveness and safety of PDC compared with TTD after LCBDE.

Methods: The PubMed, Science Citation Index, and Cochrane Central Register of Controlled Trials databases were used to accomplish a systematic literature search for randomized controlled trials and pro-/retrospective cohort studies that compared PDC alone or PDC combined with biliary drainage stenting (PDC+BD) with TTD after LCBDE. A subgroup analysis was established to compare PDC+BD with TTD. RevMan 5.3 was used for the statistical analysis.

Results: A total of 2552 patients from 26 studies were included. The pooled odds ratio supported PDC, which yielded lower postoperative overall morbidity and incidence of bile leak and bile peritonitis and shorter surgical time and postoperative hospital stay when compared with TTD. In the subgroup analysis, PDC+BD showed significantly better results in terms of postoperative overall morbidity, incidence of bile leak and bile peritonitis, surgical time, and postoperative hospital stay than did TTD. PDC and PDC+BD showed no difference in the incidence of recurrent stones and biliary stricture during the long-term follow-up period compared with TTD.

Conclusion: PDC alone or PDC+BD is superior to TTD as a duct-closure method after LCBDE.

Keywords: Biliary drainage; Laparoscopic common bile duct exploration; Primary duct closure; T-tube drainage.

Conflict of interest statement

Conflicts of Interest: All authors declare no conflict of interest regarding the publication of this article.

Figures

Figure 1.
Figure 1.
Forest plots of postoperative overall morbidity and other complications. PDC, primary duct closure; TTD, T tube drainage; BD, biliary drainage; CI:, confidence interval.
Figure 2.
Figure 2.
Forest plots of bile leak. PDC, primary duct closure; TTD, T tube drainage; BD, biliary drainage; CBD, common bile duct; CI, confidence interval.
Figure 3.
Figure 3.
Forest plots of bile peritonitis. PDC, primary duct closure; TTD, T tube drainage; BD, biliary drainage; CI, confidence interval.
Figure 4.
Figure 4.
Forest plots of CBD obstruction, postoperative pancreatitis, recurrent stones, and biliary stricture. PDC, primary duct closure; TTD, T tube drainage; BD, biliary drainage; CBD, common bile duct; CI, confidence interval.
Figure 5.
Figure 5.
Forest plots of surgical time and hospital stay. PDC, primary duct closure; TTD, T tube drainage; BD, biliary drainage; CI, confidence interval.
Figure 6.
Figure 6.
Funnel plots of the distribution of the ORs for postoperative overall morbidity and bile leak of 16 studies comparing PDC with TTD and 11 studies comparing PDC+BD with TTD. PDC, primary duct closure; TTD, T tube drainage; BD, biliary drainage; OR, odds ratio.

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Source: PubMed

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