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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

Yin, Zi MD*; Xu, Kang MD, PhD*; Sun, Jian MD*; Zhang, Jianlong MD*; Xiao, Zhiyu MD*; Wang, Jie MD, PhD*; Niu, Haitao MD; Zhao, Qiang MD; Lin, Shangxiong MD§; Li, Yajie MD*

doi: 10.1097/SLA.0b013e318268314b
Systematic Review and Meta-Analysis

Objective: This study aims to compare the efficacy and safety of T-tube free (TTF) versus T-tube drainage (TTD) after laparoscopic common bile duct exploration (LCBDE).

Background: LCBDE has been proven to be an effective and preferred treatment approach for uncomplicated choledocholithiasis, and the appropriateness of T-tube placement after laparoscopic choledochotomy for common bile duct (CBD) stones is still under debate.

Methods: A systematic literature search (PubMed, EMBASE, Science Citation Index, Springer-Link, and Cochrane Central Register of Controlled Trials) was performed. Postoperative complications were evaluated/graded according to the modified Clavien classification. Other variables extracted including primary closures of the CBDs and the associated assistant methods, T-tube types, and placement durations. Stratified and sensitivity analyses were performed both to explore heterogeneity between studies and to assess the effects of the study qualities.

Results: A total of 956 patients from 12 studies were included. The pooled odds ratio for postoperative complications and biliary-specific complications in TTF was found to be 0.59 [95% confidence interval (CI), 0.38–0.91; P = 0.02], 0.62 (95% CI, 0.36–1.06; P = 0.08), respectively, when compared with TTD. Operative time and hospital stay were significantly decreased in the TTF group, with the pooled weighted mean differences being 18.84 minutes (95% CI, −27.01 to 10.67; P < 0.01) and 3.22 days (95% CI, −4.59 to 1.84; P < 0.01), respectively.

Conclusions: The results of this meta-analysis demonstrate that among patients undergoing laparoscopic choledochotomy for common bile duct stones, primary closure of the CBD alone is superior to TTD; however, there is no significant benefit in terms of primary duct closure with various internal or external drainage techniques. Further randomized controlled trials are eagerly awaited to prove these findings.

The appropriateness of T-tube placement after laparoscopic choledochotomy for common bile duct stones is still under debate. This study demonstrates that primary closure of the common bile duct alone is superior to T-tube drainage; however, there is no significant benefit in terms of primary duct closure with various internal or external drainage techniques.

*Department of General Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University

Biotherapy Center, Cancer Center of Sun Yat-sen University

Department of General Surgery, The First Affiliated Hospital of Sun Yat-sen University

§Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.

Reprints: Jie Wang, MD, PhD, Department of General Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, 107 Yanjiang W Rd, Guangzhou, Guangdong 510120, People's Republic of China. E-mail: wjsunyatsen@gmail.com.

Disclosure: The authors declare no conflicts of interest.

© 2013 Lippincott Williams & Wilkins, Inc.