Can T-tube drainage be replaced by primary suture technique in laparoscopic common bile duct exploration? A meta-analysis of randomized controlled trials

Deng, Youcai; Tian, Hongwei; He, Lan-Juan; Zhang, Yan; Gu, Yuanhui; Ma, Yuntao

doi:10.1007/s00423-020-02000-z

Cited by 18 publications

(26 citation statements)

References 45 publications

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“…In our present study, the T-tube-related complication rate was 11.29% (7/62) in the T-tube group, which included electrolyte disturbances (3/62), drain site pain (3/62), biliary retrograde infection (1/62), and biliary peritonitis after T-tube removal or accidental displacement (2/62). Furthermore, T-tube insertion after LCBDE was associated with a prolonged hospital stay, a longer operating time, and higher hospital expenses, which is consistent with previous studies [ 7 , 9 , 10 , 35 , 36 ].…”

Section: Discussionsupporting

confidence: 91%

“…As the laparoscopic technique develops and surgeons gain more experience, LCBDE has been gradually used to address CBDS-related cholangitis [5,6]. Traditionally, LCBDE followed by T-tube placement is a widely adopted method that can drain the bile duct and remove CBD stones [7]. However, T-tube drainage may be associated with T-tube-related complications, such as drain site pain, electrolyte disturbances, biliary retrograde infection and biliary peritonitis due to tube dislodgement, or after T-tube removal and Other Interventional Techniques [8].…”

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confidence: 99%

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Efficacy and safety of laparoscopic common bile duct exploration via choledochotomy with primary closure for the management of acute cholangitis caused by common bile duct stones

et al. 2021

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Background T-tube drainage after laparoscopic common bile duct exploration (LCBDE) has been demonstrated to be safe and effective for patients with acute cholangitis caused by common bile duct stones (CBDSs). The outcomes after LCBDE with primary closure in patients with CBDS-related acute cholangitis are unknown. The present study aimed to evaluate the efficacy and safety of LCBDE with primary closure for the management of acute cholangitis caused by CBDSs. Methods Between June 2015 and June 2020, 368 consecutive patients with choledocholithiasis combined with cholecystolithiasis, who underwent laparoscopic cholecystectomy (LC) + LCBDE in our department, were retrospectively reviewed. A total of 193 patients with CBDS-related acute cholangitis underwent LC + LCBDE with primary closure of the CBD (PC group) and 62 patients underwent LC + LCBDE followed by T-tube placement (T-tube group). A total of 113 patients who did not have cholangitis were excluded. The clinical data were compared and analyzed. Results There was no mortality in either group. No significant differences were noted in morbidity, bile leakage rate, retained CBD stones, or readmission rate within 30 days between the two groups. Compared with the T-tube group, the PC group avoided T-tube-related complications and had a shorter operative time (121.12 min vs. 143.37 min) and length of postoperative hospital stay (6.59 days vs. 8.81 days). Moreover, the hospital expenses in the PC group were significantly lower than those in the T-tube group ($4844.47 vs. $5717.22). No biliary stricture occurred during a median follow-up of 18 months in any patient. No significant difference between the two groups was observed in the rate of stone recurrence. Conclusions LCBDE with primary closure is a safe and effective treatment for cholangitis caused by CBDSs. LCBDE with primary closure is not inferior to T-tube drainage for the management of CBDS-related acute cholangitis in suitable patients.

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Section: Discussionsupporting

confidence: 91%

mentioning

confidence: 99%

Efficacy and safety of laparoscopic common bile duct exploration via choledochotomy with primary closure for the management of acute cholangitis caused by common bile duct stones

et al. 2021

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“…Recent papers revealed a great controversy with no strong consensus on which method is considered the perfect one for duct closure and gives the optimal outcome regarding biliary complications [ 4 , 14 , 25 , 35 ]. To the best of our knowledge, few studies with conflicting results have been reported comparing these three techniques for CBD.…”

Section: Discussionmentioning

confidence: 99%

“…In the TTD group, a latex rubber T-tube of appropriate size (10)(11)(12)(13)(14)(15)(16) was inserted in the choledochotomy incision after its fashioning and guttering. The choledochotomy incision was closed with an interrupted 4/0 vicryl suture 3 .…”

Section: Operative Techniquesmentioning

confidence: 99%

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Comparative study of three common bile duct closure techniques after choledocholithotomy: safety and efficacy

Omar

Redwan

Alansary

2022

Langenbecks Arch Surg

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Purpose T-tube drainage, primary closure, and biliary stenting are the common bile duct closure methods. There is great debate on the optimal duct closure technique after common bile duct exploration. This study aimed to assess the safety and efficacy of the three commonest common bile duct closure methods after common bile duct exploration for common bile duct stone for future generalization. Methods In this analysis, 211 patients with common bile duct stone underwent common bile duct exploration from January 2016 to December 2020. The patients were divided according to common bile duct closure techniques into three groups, including the T-tube drainage group (63 patients), primary duct closure group (61 patients), and antegrade biliary stenting group (87 patients). Results The incidence of overall biliary complications and bile leak were statistically significantly lower in the biliary stenting group than in the other two groups. Also, hospital stays, drain carried time, return to normal activity, re-intervention, and re-admission rates were statistically significantly lower in the biliary stenting group than in the other two groups. There were no statistically significant differences regarding operative and choledochotomy time, retained and recurrent stone, stricture, biliary peritonitis, cholangitis, and the cost among the three groups. Conclusions We state that the biliary stenting procedure should be the preferred first option for common bile duct closure after common bile duct exploration when compared with T-tube drainage and primary duct closure. Trial registration ClinicalTrials.gov PRS (Approval No. NCT04264299).

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Laparoskopische Gallengangsrevision

Bulian,

Heiss

2024

Minimalinvasive Viszeralchirurgie

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Can T-tube drainage be replaced by primary suture technique in laparoscopic common bile duct exploration? A meta-analysis of randomized controlled trials

Cited by 18 publications

References 45 publications

Efficacy and safety of laparoscopic common bile duct exploration via choledochotomy with primary closure for the management of acute cholangitis caused by common bile duct stones

Efficacy and safety of laparoscopic common bile duct exploration via choledochotomy with primary closure for the management of acute cholangitis caused by common bile duct stones

Comparative study of three common bile duct closure techniques after choledocholithotomy: safety and efficacy

Laparoskopische Gallengangsrevision

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