Skip to main content

Advertisement

SpringerLink
Log in

Primary closure versus T-tube drainage after common bile duct exploration for choledocholithiasis

  • Original Article
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to evaluate the benefits and harms of primary closure versus T-tube drainage after common bile duct (CBD) exploration for choledocholithiasis.

Methods

A literature search of MEDLINE (PubMed), EMBASE, and the Cochrane Library was done to identify randomized controlled trials assessing the benefits and harms of primary closure versus T-tube drainage after CBD exploration from Jan. 1990 to Apr. 2010. A meta-analysis was set up to distinguish overall difference between the primary closure and the T-tube drainage group.

Results

There were statistically significant differences between groups: biliary complications (odds ratio (OR) 95% confidence interval (CI), 0.42 (0.19–0.92); P = 0.03), main complications (OR 95% CI, 0.46 (0.23–0.90); P = 0.02), operating time (weighted mean difference (WMD) 95% CI, −19.53 (−29.35 to −9.71); P < 0.0001), and hospital stay (WMD 95% CI, −4.16 (−7.07 to −1.24); P = 0.005) except peri-operative mortality (OR 95% CI, 0.83 (0.11–6.37); P = 0.86), residual stones (OR 95% CI, 0.70 (0.22–2.25); P = 0.55), and abdominal collections (OR 95% CI, 1.93 (0.34–10.76); P = 0.46). And the result of wound infection (OR 95% CI, 0.38 (0.14–1.02); P = 0.05) tended to favor the primary closure group.

Conclusion

The primary closure might be as effective as T-tube drainage after choledochotomy in the prevention of the development of post-operative complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Hemli JM, Arnot RS, Ashworth JJ et al (2004) Feasibility of laparoscopic common bile duct exploration in a rural centre. ANZ J Surg 74:979–982

    Article  PubMed  Google Scholar 

  2. Hungness ES, Soper NJ (2006) Management of common bile duct stones. J Gastrointest Surg 10:612–619

    Article  PubMed  Google Scholar 

  3. Perez G, Escalona A, Jarufe N et al (2005) Prospective randomized study of T-tube versus biliary stent for common bile duct decompression after open choledocotomy. World J Surg 29:869–872

    Article  PubMed  Google Scholar 

  4. Ponsky JL, Heniford BT, Gersin K (2000) Choledocholithiasis: evolving intraoperative strategies. Am Surg 66:262–268

    CAS  PubMed  Google Scholar 

  5. Verbesey JE, Birkett DH (2008) Common bile duct exploration for choledocholithiasis. Surg Clin N Am 88:1315–1328, ix

    Article  PubMed  Google Scholar 

  6. Zhang WJ, Xu GF, Wu GZ et al (2009) Laparoscopic exploration of common bile duct with primary closure versus T-tube drainage: a randomized clinical trial. J Surg Res 157:e1–5

    Article  PubMed  Google Scholar 

  7. Ambreen M, Shaikh AR, Jamal A et al (2009) Primary closure versus T-tube drainage after open choledochotomy. Asian J Surg 32:21–25

    Article  CAS  PubMed  Google Scholar 

  8. Leida Z, Ping B, Shuguang W, Yu H (2008) A randomized comparison of primary closure and T-tube drainage of the common bile duct after laparoscopic choledochotomy. Surg Endosc 22:1595–1600

    Article  PubMed  Google Scholar 

  9. Williams JA, Treacy PJ, Sidey P et al (1994) Primary duct closure versus T-tube drainage following exploration of the common bile duct. Aust N Z J Surg 64:823–826

    Article  CAS  PubMed  Google Scholar 

  10. Burhenne HJ (1972) Non-operative retained biliary tract stone extraction. Calif Med 117:57

    CAS  PubMed  Google Scholar 

  11. Berci G, Shore M, Morgenstern L, Hamlin A (1978) Choledochoscopy and operative fluorocholangiography in the prevention of retained bile duct stones. World J Surg 2:411–427

    Article  CAS  PubMed  Google Scholar 

  12. Cotton PB (1980) Non-operative removal of bile duct stones by duodenoscopic sphincterotomy. Br J Surg 67:1–5

    Article  CAS  PubMed  Google Scholar 

  13. Hauer-Jensen M, Karesen R, Nygaard K et al (1985) Predictive ability of choledocholithiasis indicators. A prospective evaluation. Ann Surg 202:64–68

    Article  CAS  PubMed  Google Scholar 

  14. Worthley CS, Watts JM, Toouli J (1989) Common duct exploration or endoscopic sphincterotomy for choledocholithiasis? Aust N Z J Surg 59:209–215

    Article  CAS  PubMed  Google Scholar 

  15. Halstead W (1900) Contributions to surgery of the bile passages, especially of the common bile duct. Bull Johns Hopkins Hosp 106:1–11

    Google Scholar 

  16. Thornton J (1881) Observations on additional cases illustrating hepatic surgery. Lancet 1:763

    Google Scholar 

  17. Seale AK, Ledet WP Jr (1999) Primary common bile duct closure. Arch Surg 134:22–24

    Article  CAS  PubMed  Google Scholar 

  18. Tu Z, Li J, Xin H et al (1999) Primary choledochorrhaphy after common bile duct exploration. Dig Surg 16:137–139

    Article  CAS  PubMed  Google Scholar 

  19. Gurusamy KS, Samraj K (2007) Primary closure versus T-tube drainage after laparoscopic common bile duct stone exploration. Cochrane Database Syst Rev CD005641

  20. Gurusamy KS, Samraj K (2007) Primary closure versus T-tube drainage after open common bile duct exploration. Cochrane Database Syst Rev CD005640

  21. Jadad AR, Moore RA, Carroll D et al (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12

    Article  CAS  PubMed  Google Scholar 

  22. Moher D, Cook DJ, Eastwood S et al (2000) Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. QUOROM Group. Br J Surg 87:1448–1454

    Article  CAS  PubMed  Google Scholar 

  23. Marwah S, Singh I, Godara R et al (2004) Evaluation of primary duct closure vs T-tube drainage following choledochotomy. Indian J Gastroenterol 23:227–228

    PubMed  Google Scholar 

  24. Zhang LD, Bie P, Chen P et al (2004) Primary duct closure versus T-tube drainage following laparoscopic choledochotomy]. Zhonghua Wai Ke Za Zhi 42:520–523

    PubMed  Google Scholar 

  25. Pakula R, Konikoff FM, Moser AM et al (1999) The effects of short term lipid infusion on plasma and hepatic bile lipids in humans. Gut 45:453–458

    Article  CAS  PubMed  Google Scholar 

  26. Lau WY, Chu KW, Yuen WK et al (1991) Operative choledochoscopy in patients with acute cholangitis: a prospective, randomized study. Br J Surg 78:1226–1229

    Article  CAS  PubMed  Google Scholar 

  27. Litynski GS (1998) Erich Muhe and the rejection of laparoscopic cholecystectomy (1985): a surgeon ahead of his time. JSLS 2:341–346

    CAS  PubMed  Google Scholar 

  28. Yamazaki M, Yasuda H, Tsukamoto S et al (2006) Primary closure of the common bile duct in open laparotomy for common bile duct stones. J Hepatobiliary Pancreat Surg 13:398–402

    Article  PubMed  Google Scholar 

  29. De Roover D, Vanderveken M, Gerard Y (1989) Choledochotomy: primary closure versus T-tube. A prospective trial. Acta Chir Belg 89:320–324

    PubMed  Google Scholar 

  30. Paganini AM, Feliciotti F, Guerrieri M et al (2001) Laparoscopic common bile duct exploration. J Laparoendosc Adv Surg Tech A 11:391–400

    Article  CAS  PubMed  Google Scholar 

  31. Rienhoff WF (1960) Primary closure of the common duct. Ann Surg 151:255–260

    Article  CAS  PubMed  Google Scholar 

  32. Moreaux J (1995) Traditional surgical management of common bile duct stones: a prospective study during a 20-year experience. Am J Surg 169:220–226

    Article  CAS  PubMed  Google Scholar 

  33. Payne RA, Woods WG (1986) Primary suture or T-tube drainage after choledochotomy. Ann R Coll Surg Engl 68:196–198

    CAS  PubMed  Google Scholar 

  34. Lygidakis NJ (1983) Choledochotomy for biliary lithiasis: T-tube drainage or primary closure. Effects on postoperative bacteremia and T-tube bile infection. Am J Surg 146:254–256

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General Surgery, The First Affiliated Hospital, Wenzhou Medical College, Wenzhou, 325003, Zhejiang, China

    Qian D. Zhu, Chong L. Tao, Meng T. Zhou, Zheng P. Yu, Hong Q. Shi & Qi Y. Zhang

Authors
  1. Qian D. Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chong L. Tao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Meng T. Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Zheng P. Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hong Q. Shi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Qi Y. Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Qi Y. Zhang.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zhu, Q.D., Tao, C.L., Zhou, M.T. et al. Primary closure versus T-tube drainage after common bile duct exploration for choledocholithiasis. Langenbecks Arch Surg 396, 53–62 (2011). https://doi.org/10.1007/s00423-010-0660-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-010-0660-z

Keywords

Search

Navigation