Primary closure<i>versus</i> T-tube drainage in laparoscopic common bile duct exploration: a meta-analysis _CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

Baheti·KALIFU , GE Xiaohu , MENG Yuan , Yimamu·ABULA , CHEN Lunjian , MA Zhigang , XIONG Ju ,  CHEN Xiong

Department of Hepatobiliary Surgery, People’s Hospital of The Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang 830001, P.R.China;

Corresponding author：

CHEN Xiong, Email: nhcx@123.com

Keywords：

common bile duct; laparoscopic common bile duct exploration; T-tube drainage; primary closure

DOI：

10.7507/1007-9424.201608024

Video：

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Objective To evaluate the safety and efficacy of primary closure (PC) and T-tube drainage (TD) after laparoscopic common bile duct exploration (LCBDE). Methods The randomized controlled trials of PC and TD after LCBDE were retrieved from the Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until April 2015. All calculations and statistical tests were performed using ReviewerManager 5.2 software. Results Both of the two groups had no postoperative deaths within 30 days. The operative time and hospital stay of PC gourp were shorter than TD group statistically〔OR=–24.76, 95CI (–29.21, –20.31),P<0.000 01〕and〔OR=–2.68, 95%CI (–3.69, –1.67),P<0.000 01〕. The reoperative rate of PC group was lower than that of TD group, and the difference was statistically significant〔OR=0.20, 95%CI (0.05, 0.81),P=0.02〕. There was no significant difference between the two groups in the occurrence of postoperative severe complications〔OR=0.54, 95%CI (0.26, 1.12),P=0.10〕. Conclusions Compared with the TD group, the operative time and hospitalization time are shorer in PC group, and complication rate is similar, but the cost of treatment of the TD group is higher than PC group, so after LCBDE a primary closure of common bile duct is safe and effective method.

Citation： Baheti·KALIFU, GE Xiaohu, MENG Yuan, Yimamu·ABULA, CHEN Lunjian, MA Zhigang, XIONG Ju, CHEN Xiong. Primary closureversus T-tube drainage in laparoscopic common bile duct exploration: a meta-analysis . CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(4): 489-495. doi: 10.7507/1007-9424.201608024 Copy

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2.	Halldestam I, Enell EL, Kullman E,et al. Development of symptoms and complications in individuals with asymptomatic gallstones. Br J Surg, 2004, 91(6): 734-738.
3.	Ballal M, David G, Willmott S,et al. Conversion after laparoscopic cholecystectomy in England. Surg Endosc, 2009, 23(10): 2338-2344.
4.	Livingston EH, Rege RV. A nationwide study of conversion from laparoscopic to open cholecystectomy. Am J Surg, 2004, 188(3): 205-211.
5.	Gurusamy K, Sahay SJ, Burroughs AK,et al. Systematic review and meta-analysis of intraoperativeversus preoperative endoscopic sphincterotomy in patients with gallbladder and suspected common bile duct stones. Br J Surg, 2011, 98(7): 908-916.
6.	Ebner S, Rechner J, Beller S,et al. Laparoscopic management of common bile duct stones. Surg Endosc, 2004, 18(5): 762-765.
7.	Waage A, Stromberg C, Leijonmarck CE,et al. Long-term results from laparoscopic common bile ductexploration. Surg Endosc, 2003, 17(8): 1181-1185.
8.	Rojas-Ortega S1, Arizpe-Bravo D, Marín López ER,et al. Transcystic common bile duct exploration in the management of patients with choledocholithiasis. J Gastrointest Surg, 2003, 7(4): 492-496.
9.	Decker G, Borie F, Millat B,et al. One hundred laparoscopic choledochotomies with primary closure of the common bile duct. Surg Endosc, 2003, 17(1): 12-18.
10.	Wills VL, Gibson K, Karihaloot C,et al. Complications of biliary T-tubes after choledochotomy. ANZ J Surg, 2002, 72(3): 177-180.
11.	Becker LA, Oxman AD. Chapter 22: Overviews of reviews. In: Higgings JPT, Green S. ed. The Cochrane Handbook for Systematic Reviews of Interventions Virsion5.1.0 [updated March 2011] the Cochrane Collaboration 2011,.
12.	El-Geidie AA. Is the use of T-tube necessary after laparoscopic choledochotomy? J Gastrointest Surg, 2010, 14(5): 844-848.
13.	Leida Z, Ping B, Shuguang W,et al. A randomized comparison of primary closure and T-tube drainage of the common bile duct after laparoscopic choledochotomy. Surg Endosc, 2008, 22(7): 1595-1600.
14.	Zhang WJ, Xu GF, Wu GZ,et al. Laparoscopic exploration of common bile duct with primary closureversus T-tube drainage: a randomized clinical trial. J Surg Res, 2009, 157(1): e1-e5.
15.	Dong ZT, Wu GZ, Luo KL,et al. Primary closure after laparoscopic common bile duct explorationversus T-tube. J Surg Res, 2014, 189(2): 249-254.
16.	Clavien PA, Barkun J, de Oliveira ML,et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg, 2009, 250(2): 187-196.
17.	Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6 336 patients and results of a survey. Ann Surg, 2004, 240(2): 205-213.
18.	Yin Z, Xu K, Sun J,et al. Is the end of the T-tube drainage era in laparoscopic choledochotomy for common bile duct stones is coming? A systematic review and meta-analysis. Ann Surg, 2013, 257(1): 54-66.
19.	Wang C, Wang Q, Sun D,et al. Immunogenic alteration in laparoscopic common bile duct exploration. J Surg Res, 2014, 187(1): 302-309.
20.	Coppola R, Riccioni ME, Ciletti S,et al. Analysis of complications of endoscopic sphincterotomy for biliary stones in a consecutive series of 546 patients. Surg Endosc, 1997, 11(2): 129-132.
21.	Noble H, Tranter S, Chesworth T,et al. A randomized,clinical trial to compare endoscopic sphincterotomy and subsequent laparoscopic cholecystectomy with primary laparoscopic bile duct exploration during cholecystectomy in higher risk patients with choledocholithiasis. J Laparoendosc Adv Surg Tech A, 2009, 19(6): 713-720.
22.	Rogers SJ, Cello JP, Horn JK,et al. Prospective randomized trial of LC+LCBDEvs ERCP/S+LC for common bile duct stone disease. Arch Surg, 2010, 145(1): 28-33.
23.	Martin DJ, Vernon DR, Toouli J. Surgicalversus endoscopic treatment of bile duct stones. Cochrane Database Syst Rev, 2006, 2: CD003327.
24.	Gurusamy KS, Koti R, Davidson BR. T-tube drainageversus primary closure after open common bile duct stone exploration. Cochrane Database Syst Rev, 2013, 6: CD005640.
25.	Williams JA, Treacy PJ, Sidey P,et al. Primary duct closureversus T-tube drainage following exploration of the common bile duct. Aust N Z J Surg, 1994, 64(12): 823-826.
26.	Ha JP, Tang CN, Siu WT,et al. Primary closureversus T-tube drainage after laparoscopic choledochotomy for common bile duct stones. Hepatogastroenterology, 2004, 51(60): 1605-1608.
27.	Jameel M, Darmas B, Baker AL. Trend towards primary closure following laparoscopic exploration of the common bile duct. Ann R Coll Surg Engl, 2008, 90(1): 29-35.
28.	Noh KT, Min SK, Lee HK. Comparison of primary closure and T-tube drainage following laparoscopic CBD exploration. J Korean Surg Society, 2009, 77(6): 399-403.

1. Attili AF, De Santis A, Capri R,et al. The natural history of gallstones: the GREPCO experience. The GREPCO group. Hepatology, 1995, 21(3): 655-660.
2. Halldestam I, Enell EL, Kullman E,et al. Development of symptoms and complications in individuals with asymptomatic gallstones. Br J Surg, 2004, 91(6): 734-738.
3. Ballal M, David G, Willmott S,et al. Conversion after laparoscopic cholecystectomy in England. Surg Endosc, 2009, 23(10): 2338-2344.
4. Livingston EH, Rege RV. A nationwide study of conversion from laparoscopic to open cholecystectomy. Am J Surg, 2004, 188(3): 205-211.
5. Gurusamy K, Sahay SJ, Burroughs AK,et al. Systematic review and meta-analysis of intraoperativeversus preoperative endoscopic sphincterotomy in patients with gallbladder and suspected common bile duct stones. Br J Surg, 2011, 98(7): 908-916.
6. Ebner S, Rechner J, Beller S,et al. Laparoscopic management of common bile duct stones. Surg Endosc, 2004, 18(5): 762-765.
7. Waage A, Stromberg C, Leijonmarck CE,et al. Long-term results from laparoscopic common bile ductexploration. Surg Endosc, 2003, 17(8): 1181-1185.
8. Rojas-Ortega S1, Arizpe-Bravo D, Marín López ER,et al. Transcystic common bile duct exploration in the management of patients with choledocholithiasis. J Gastrointest Surg, 2003, 7(4): 492-496.
9. Decker G, Borie F, Millat B,et al. One hundred laparoscopic choledochotomies with primary closure of the common bile duct. Surg Endosc, 2003, 17(1): 12-18.
10. Wills VL, Gibson K, Karihaloot C,et al. Complications of biliary T-tubes after choledochotomy. ANZ J Surg, 2002, 72(3): 177-180.
11. Becker LA, Oxman AD. Chapter 22: Overviews of reviews. In: Higgings JPT, Green S. ed. The Cochrane Handbook for Systematic Reviews of Interventions Virsion5.1.0 [updated March 2011] the Cochrane Collaboration 2011,.
12. El-Geidie AA. Is the use of T-tube necessary after laparoscopic choledochotomy? J Gastrointest Surg, 2010, 14(5): 844-848.
13. Leida Z, Ping B, Shuguang W,et al. A randomized comparison of primary closure and T-tube drainage of the common bile duct after laparoscopic choledochotomy. Surg Endosc, 2008, 22(7): 1595-1600.
14. Zhang WJ, Xu GF, Wu GZ,et al. Laparoscopic exploration of common bile duct with primary closureversus T-tube drainage: a randomized clinical trial. J Surg Res, 2009, 157(1): e1-e5.
15. Dong ZT, Wu GZ, Luo KL,et al. Primary closure after laparoscopic common bile duct explorationversus T-tube. J Surg Res, 2014, 189(2): 249-254.
16. Clavien PA, Barkun J, de Oliveira ML,et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg, 2009, 250(2): 187-196.
17. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6 336 patients and results of a survey. Ann Surg, 2004, 240(2): 205-213.
18. Yin Z, Xu K, Sun J,et al. Is the end of the T-tube drainage era in laparoscopic choledochotomy for common bile duct stones is coming? A systematic review and meta-analysis. Ann Surg, 2013, 257(1): 54-66.
19. Wang C, Wang Q, Sun D,et al. Immunogenic alteration in laparoscopic common bile duct exploration. J Surg Res, 2014, 187(1): 302-309.
20. Coppola R, Riccioni ME, Ciletti S,et al. Analysis of complications of endoscopic sphincterotomy for biliary stones in a consecutive series of 546 patients. Surg Endosc, 1997, 11(2): 129-132.
21. Noble H, Tranter S, Chesworth T,et al. A randomized,clinical trial to compare endoscopic sphincterotomy and subsequent laparoscopic cholecystectomy with primary laparoscopic bile duct exploration during cholecystectomy in higher risk patients with choledocholithiasis. J Laparoendosc Adv Surg Tech A, 2009, 19(6): 713-720.
22. Rogers SJ, Cello JP, Horn JK,et al. Prospective randomized trial of LC+LCBDEvs ERCP/S+LC for common bile duct stone disease. Arch Surg, 2010, 145(1): 28-33.
23. Martin DJ, Vernon DR, Toouli J. Surgicalversus endoscopic treatment of bile duct stones. Cochrane Database Syst Rev, 2006, 2: CD003327.
24. Gurusamy KS, Koti R, Davidson BR. T-tube drainageversus primary closure after open common bile duct stone exploration. Cochrane Database Syst Rev, 2013, 6: CD005640.
25. Williams JA, Treacy PJ, Sidey P,et al. Primary duct closureversus T-tube drainage following exploration of the common bile duct. Aust N Z J Surg, 1994, 64(12): 823-826.
26. Ha JP, Tang CN, Siu WT,et al. Primary closureversus T-tube drainage after laparoscopic choledochotomy for common bile duct stones. Hepatogastroenterology, 2004, 51(60): 1605-1608.
27. Jameel M, Darmas B, Baker AL. Trend towards primary closure following laparoscopic exploration of the common bile duct. Ann R Coll Surg Engl, 2008, 90(1): 29-35.
28. Noh KT, Min SK, Lee HK. Comparison of primary closure and T-tube drainage following laparoscopic CBD exploration. J Korean Surg Society, 2009, 77(6): 399-403.

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Primary closureversus T-tube drainage in laparoscopic common bile duct exploration: a meta-analysis

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