Should T-Tube Drainage be Performed for Choledocholithiasis after Laparoscopic Common Bile Duct Exploration? A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Zhang, Woods; Li, Ge; Chen, Yanling

doi:10.1097/sle.0000000000000472

Cited by 17 publications

(15 citation statements)

References 19 publications

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“…A total of 369 articles were identified through the electronic database search (368 articles) and manual search (one article); the manually retrieved study 21 was identified from the reference list of one of the other relevant articles. 22 After reviewing the titles and abstracts of these obtained articles, 339 were excluded because they were irrelevant studies, noncontrol studies, systematic reviews, animal studies, or studies that focused on open common bile duct exploration (CBDE). The full texts of the 30 remaining studies were then assessed.…”

Section: Resultsmentioning

confidence: 99%

T-Tube Use After Laparoscopic Common Bile Duct Exploration

Jiang

Zhao

Cheng

2019

JSLS

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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.

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Section: Resultsmentioning

confidence: 99%

T-Tube Use After Laparoscopic Common Bile Duct Exploration

Jiang

Zhao

Cheng

2019

JSLS

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“…The operation for AC in the elderly should be simple, quick, and effective because the basic health status of elderly patients is usually poor. Operation methods have improved from the traditional open bile duct exploration to laparoscopic bile duct exploration and a transcystic procedure or T-tube drainage, and now ultrasound-guided puncture and endoscopic techniques have become widely accepted [11][12][13]. Elderly patients differ significantly in terms of their clinical symptoms, physical signs, and actual physical condition owing to their declining physiological condition and reduced immunity.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of emergency laparoscopic common bile duct exploration in elderly patients with complicated acute cholangitis

et al. 2019

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Background Acute cholangitis (AC) is an acute inflammation of the biliary tract caused by bacterial infection, which occurs due to biliary obstruction primarily because of bile duct stones. We aimed to study the effect of laparoscopic common bile duct exploration in the treatment of complicated AC for elderly patients. Method Elderly patients with complicated AC admitted to our hospital from August 2014 to August 2018 were considered. According to the patients' general conditions and the American Society of Anesthesiologists' (ASA) grade, 98 patients were divided into three groups: ASA grade II, 38 patients; ASA grade III, 33 patients; and ASA grade IV, 27 patients; all patients underwent emergency laparoscopic common bile duct exploration within 8 h of admission. The perioperative data of these patients were analyzed. Results There were no significant differences between the three groups in preoperative laboratory test results, except for albumin levels. Conversely, when compared in every group, there were some significant differences in changes between pre-and postoperative laboratory test results, except for albumin levels. There were no significant differences between the groups in terms of perioperative data (operation time, blood loss, peritoneal drainage time, postoperative time to flatus, and postoperative hospital stay). Although four patients had postoperative complications, there were no significant differences in the rate of complications between the groups. Conclusion Laparoscopic common bile duct exploration is a safe, effective, and feasible method for treating complicated AC in elderly patients. It should be actively used in clinical work to rapidly relieve biliary obstruction.

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“…Therefore, surgery without T‐tubes has become a hot research area for treating CBDS. So far, most studies focused on primary closure of the CBD by multi‐port LCBDE . We started our study of single‐incision LCBDE (SILCBDE) without T‐tube in 2010.…”

Section: Introductionmentioning

confidence: 99%

“…So far, most studies focused on primary closure of the CBD by multi-port LCBDE. 3 We started our study of single-incision LCBDE (SILCBDE) without T-tube in 2010. This study describes our single centre experience with T-tube-free SILCBDE + LC for treating CBDS using conventional instruments.…”

Section: Introductionmentioning

confidence: 99%

T‐tube‐free single‐incision laparoscopic common bile duct exploration plus cholecystectomy: a single centre experience

Yao

Tian

Yao

et al. 2019

ANZ Journal of Surgery

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Background The present study aimed to explore the indications and feasibility of T‐tube‐free trans‐umbilical single‐incision laparoscopic common bile duct exploration (SILCBDE) plus laparoscopic cholecystectomy (LC) for treating choledocholithiasis. Methods Patients hospitalized in the Second Affiliated Hospital (Shengjing Hospital) of China Medical University from January 2010 to January 2017 with the diagnosis of common bile duct stones and treated with T‐tube‐free trans‐umbilical single‐incision LC plus common bile duct exploration were retrospectively analysed. Results A total of 37 male/female choledocholithiasis patients (mean age 65 years, range 29–86) were treated with T‐tube‐free trans‐umbilical SILCBDE plus LC. No intraoperative complication or conversion to open surgery occurred in any of the cases. The mean operative time was 99.8 min (range 84–125) for endoscopic nasobiliary drainage group (n = 6), 113.8 min (range 70–150) for endoscopic retrogradebiliary drainage group (n = 2), 131.1 min (range 75–161) for pigtail J‐tube group (n = 24), 113.7 min (range 100–150) for primary closure group (n = 5). The mean post‐operative hospital stay length was 5.5 days (range 4–7) for endoscopic nasobiliary drainage group, 12.5 days (range 10–15) for endoscopic retrogradebiliary drainage group, 6.5 days (range 4–10) for J‐tube group, 5.8 days (range 4–9) for primary closure group. Pancreatitis, bile leakage and peritonitis were not presented in any of the group. After 17–101 months follow‐up, three patients presented recurrent common bile duct stones. Conclusion In selected cases, T‐tube‐free trans‐umbilical SILCBDE plus LC is feasible and safe for experienced surgeons, and can achieve similar therapeutic effects as common LC plus common bile duct exploration procedures.

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Should T-Tube Drainage be Performed for Choledocholithiasis after Laparoscopic Common Bile Duct Exploration? A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract: In this meta-analysis, there was no evidence provided for clinical benefits of using TTD after LCBDE. Therefore, TTD should not routinely be performed after LCBDE. However, multicenter, large sample size, RCTs should be conducted to clarify this issue.

Cited by 17 publications

References 19 publications

T-Tube Use After Laparoscopic Common Bile Duct Exploration

T-Tube Use After Laparoscopic Common Bile Duct Exploration

Safety and efficacy of emergency laparoscopic common bile duct exploration in elderly patients with complicated acute cholangitis

T‐tube‐free single‐incision laparoscopic common bile duct exploration plus cholecystectomy: a single centre experience

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