Systematic review with meta-analysis of studies comparing primary duct closure and T-tube drainage after laparoscopic common bile duct exploration for choledocholithiasis

Mauro Podda, Francesco Maria Polignano, Andreas Luhmann, Michael Samuel James Wilson, Christoph Kulli, Iain Stephen Tait

Research output: Contribution to journalArticle

Abstract

Background: With advances in laparoscopic instrumentation and acquisition of advanced laparoscopic skills, laparoscopic common bile duct exploration (LCBDE) is technically feasible and increasingly practiced by surgeons worldwide. Traditional practice of suturing the dochotomy with T-tube drainage may be associated with T-tube-related complications. Primary duct closure (PDC) without a T-tube has been proposed as an alternative to T-tube placement (TTD) after LCBDE. The aim of this meta-analysis was to evaluate the safety and effectiveness of PDC when compared to TTD after LCBDE for choledocholithiasis. Methods: A systematic literature search was performed using PubMed, EMBASE, MEDLINE, Google Scholar, and the Cochrane Central Register of Controlled Trials databases for studies comparing primary duct closure and T-tube drainage. Studies were reviewed for the primary outcome measures: overall postoperative complications, postoperative biliary-specific complications, re-interventions, and postoperative hospital stay. Secondary outcomes assessed were: operating time, median hospital expenses, and general complications. Results: Sixteen studies comparing PDC and TTD qualified for inclusion in our meta-analysis, with a total of 1770 patients. PDC showed significantly better results when compared to TTD in terms of postoperative biliary peritonitis (OR 0.22, 95 % CI 0.06–0.76, P = 0.02), operating time (WMD, −22.27, 95 % CI −33.26 to −11.28, P 

Original languageEnglish
Pages (from-to)845-861
Number of pages17
JournalSurgical Endoscopy and Other Interventional Techniques
Volume30
Issue number3
DOIs
Publication statusPublished - Mar 1 2016

Keywords

  • Choledochotomy
  • Cholelithiasis
  • Common bile duct exploration
  • Laparoscopy
  • Primary duct closure
  • T-tube

ASJC Scopus subject areas

  • Surgery

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