Skip to main content
SpringerLink
Log in

Greater than or equal to 8 mm is a safe diameter of common bile duct for primary duct closure: single-arm meta-analysis and systematic review

  • Clinical Review
  • Published:
Clinical Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Greater than or equal to 8 mm was often used as the safe diameter of primary duct closure (PDC) after laparoscopic common bile duct exploration (LCBDE) in previous studies, but it is impossible to verify the source of this safe diameter, and lack of evidence for the safe diameter of PDC. Hence, this study evaluates the incidence of postoperative complications by single-arm meta-analysis to demonstrate the feasibility of using 8 mm as the safe diameter of PDC, so as to provide reference for clinical selection. Eligible studies were searched by MEDLINE, the Cochrane Library, Embase, and Web of Science from January 1995 to May 2021, investigating eligible literature using PDC after LCBDE for methods of common bile duct closure. The single-arm meta-analysis was analyzed by “meta” package under R 4.0.5, and the pooled incidence of postoperative complications was calculated. Twelve literatures were enrolled in this single-arm meta-analysis including 792 patients. The pooled complications rate including total complications (13.1%, 95% CI 10.1–15.6%), total biliary duct-related complications (9.4%, 95% CI 7.4–11.6%), residual stones (1.3%, 95% CI 0.3–2.7%), bile leakage (5.1%, 95% CI 3.5–6.9%), postoperative pneumonia (2.1%, 95% CI 0.8–3.8%), postoperative acute pancreatitis (1.8%, 95% CI 0.2–4.3%), and stone recurrence (2.6%, 95% CI 1.1–4.4%). The clinical indication of PDC after LCBDE should follow that the diameter of common bile duct ≥ 8 mm as the safe diameter.

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
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

Data availability

All data were derived from previously published studies, so the data availability statement is not required.

References

  1. Katsinelos P, Galanis I, Pilpilidis I, et al. The effect of indwelling endoprosthesis on stone size or fragmentation after long-term treatment with biliary stenting for large stones. Surg Endosc. 2003;17:1552–5.

    Article  CAS  Google Scholar 

  2. Lyu Y, Cheng Y, Li T, et al. Laparoscopic common bile duct exploration plus cholecystectomy versus endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy for cholecystocholedocholithiasis: a meta-analysis. Surg Endosc. 2019;33:3275–86.

    Article  Google Scholar 

  3. Dasari BV, Tan CJ, Gurusamy KS et al. Surgical versus endoscopic treatment of bile duct stones. Cochrane Database Syst Rev 2013:CD003327

  4. Wu X, Yang Y, Dong P, et al. Primary closure versus T-tube drainage in laparoscopic common bile duct exploration: a meta-analysis of randomized clinical trials. Langenbecks Arch Surg. 2012;397:909–16.

    Article  Google Scholar 

  5. Podda M, Polignano FM, Luhmann A, et al. Systematic review with meta-analysis of studies comparing primary duct closure and T-tube drainage after laparoscopic common bile duct exploration for choledocholithiasis. Surg Endosc. 2016;30:845–61.

    Article  Google Scholar 

  6. He MY, Zhou XD, Chen H, et al. Various approaches of laparoscopic common bile duct exploration plus primary duct closure for choledocholithiasis: a systematic review and meta-analysis. Hepatobiliary Pancreatic Dis Int: HBPD INT. 2018;17:183–91.

    Article  Google Scholar 

  7. Hua J, Lin S, Qian D, et al. Primary closure and rate of bile leak following laparoscopic common bile duct exploration via choledochotomy. Dig Surg. 2015;32:1–8.

    Article  Google Scholar 

  8. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700.

    Article  Google Scholar 

  9. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25:603–5.

    Article  Google Scholar 

  10. Davison SN, Rathwell S, Ghosh S, et al. The prevalence and severity of chronic pain in patients with chronic kidney disease: a systematic review and meta-analysis. Can J Kidney Health Dis. 2021;8:2054358121993995.

    Article  Google Scholar 

  11. Liu Z, Wang Y, Yan J, et al. Efficacy and safety of recombinant human interleukin-11 in the treatment of acute leukaemia patients with chemotherapy-induced thrombocytopenia: a systematic review and meta-analysis. J Eval Clin Pract. 2020;26:262–71.

    Article  Google Scholar 

  12. Zhen W, Xu-Zhen W, Nan-Tao F, et al. Primary closure versus T-tube drainage following laparoscopic common bile duct exploration in patients with previous biliary surgery. Am Surg. 2021;87:50–5.

    Article  Google Scholar 

  13. Zhou H, Wang S, Fan F, et al. Primary closure with knotless barbed suture versus traditional T-tube drainage after laparoscopic common bile duct exploration: a single-center medium-term experience. J Int Med Res. 2020;48:300060519878087.

    PubMed  Google Scholar 

  14. Yang Y, Han L, Lin DN, et al. The safety and efficacy of primary duct closure without endoscopic nasobiliary drainage after laparoscopic common bile duct exploration. Gastrointestinal Tumors. 2020;7:117–24.

    Article  Google Scholar 

  15. Wu X, Huang ZJ, Zhong JY, et al. Laparoscopic common bile duct exploration with primary closure is safe for management of choledocholithiasis in elderly patients. Hepatobiliary Pancreatic Dis Int: HBPD INT. 2019;18:557–61.

    Article  Google Scholar 

  16. Wen SQ, Hu QH, Wan M, et al. Appropriate patient selection is essential for the success of primary closure after laparoscopic common bile duct exploration. Dig Dis Sci. 2017;62:1321–6.

    Article  Google Scholar 

  17. Liu D, Cao F, Liu J, et al. Risk factors for bile leakage after primary closure following laparoscopic common bile duct exploration: a retrospective cohort study. BMC Surg. 2017;17:1.

    Article  Google Scholar 

  18. Zhang WJ, Xu GF, Huang Q, et al. Treatment of gallbladder stone with common bile duct stones in the laparoscopic era. BMC Surg. 2015;15:7.

    Article  Google Scholar 

  19. Yi HJ, Hong G, Min SK, et al. Long-term outcome of primary closure after laparoscopic common bile duct exploration combined with choledochoscopy. Surg Laparosc Endosc Percutan Tech. 2015;25:250–3.

    Article  Google Scholar 

  20. Muzaffar I, Zula P, Yimit Y, et al. Randomized comparison of postoperative short-term and mid-term complications between T-tube and primary closure after CBD exploration. J College Phys Surg-Pakistan: JCPSP. 2014;24:810–4.

    Google Scholar 

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

    Article  Google Scholar 

  22. Ambreen M, Shaikh AR, Jamal A, et al. Primary closure versus T-tube drainage after open choledochotomy. Asian J Surg. 2009;32:21–5.

    Article  CAS  Google Scholar 

  23. 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;22:1595–600.

    Article  Google Scholar 

  24. Singh S, Aoun E, Thakkar S. Endoscopic management of a major bile duct stricture from surgical clips following laparoscopic hemicolectomy. BMJ Case Rep. 2013. https://doi.org/10.1136/bcr-2012-007982.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Fan L, Wang J, Dai WC, et al. Laparoscopic transcystic common bile duct exploration: surgical indications and procedure strategies. Surg Endosc. 2018;32:4742–8.

    Article  Google Scholar 

  26. Parsi MA. Common controversies in management of biliary strictures. World J Gastroenterol. 2017;23:1119–24.

    Article  Google Scholar 

  27. Rahman S, Krokidis M, Paraskevopoulos I. Transcholecystic approach for distal common bile duct stricture in a non-dilated biliary system: an alternative route. BMJ Case Rep. 2019. https://doi.org/10.1136/bcr-2019-231153.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Fernandez-Simon A, Diaz-Gonzalez A, Thuluvath PJ, et al. Endoscopic retrograde cholangiography for biliary anastomotic strictures after liver transplantation. Clin Liver Dis. 2014;18:913–26.

    Article  Google Scholar 

  29. Palermo M, Fendrich I, Ronchi A, et al. Laparoscopic common bile duct exploration using a single-operator cholangioscope. J Laparoendosc Adv Surg Tech A. 2020;30:989–92.

    Article  Google Scholar 

  30. Sanchez A, Otano N, Rodriguez O, et al. Laparoscopic common bile duct exploration four-task training model: construct validity. JSLS: J Soc Laparoendoscopic Surg. 2012;16:10–5.

    Article  Google Scholar 

  31. El Nakeeb A, El Sorogy M, Hamed H, et al. Biliary leakage following pancreaticoduodenectomy: prevalence, risk factors and management. Hepatobiliary Pancreatic Dis Int: HBPD INT. 2019;18:67–72.

    Article  Google Scholar 

  32. Uchiyama K, Onishi H, Tani M, et al. Long-term prognosis after treatment of patients with choledocholithiasis. Ann Surg. 2003;238:97–102.

    PubMed  PubMed Central  Google Scholar 

  33. Jiang C, Zhao X, Cheng S. T-Tube Use After Laparoscopic Common Bile Duct Exploration. JSLS: J Soc Laparoendoscopic Surg. 2019;23: e201800077.

    Article  Google Scholar 

  34. Kim DI, Kim MH, Lee SK, et al. Risk factors for recurrence of primary bile duct stones after endoscopic biliary sphincterotomy. Gastrointest Endosc. 2001;54:42–8.

    Article  CAS  Google Scholar 

  35. Hao L, Bi YW, Zhang D, et al. Risk factors and nomogram for common bile duct stricture in chronic pancreatitis: a cohort of 2153 patients. J Clin Gastroenterol. 2019;53:e91–100.

    Article  Google Scholar 

  36. Pereira-Lima JC, Jakobs R, Winter UH, et al. Long-term results (7 to 10 years) of endoscopic papillotomy for choledocholithiasis. Multivariate analysis of prognostic factors for the recurrence of biliary symptoms. Gastrointest Endosc. 1998;48:457–64.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The authors would like to express their deepest gratitude to Nakashima Mika.

Funding

This study was supported by Project of Science and Technology Department of Qinghai Province (2020-ZJ-Y01), and General Project of Qinghai Provincial Health Commission (2018-wjzdx-118).

Author information

Author notes

  1. Manjun Deng and Jingxin Yan have contributed equally in this work.

Authors and Affiliations

  1. Department of Hepatopancreatobiliary Surgery, Affiliated Hospital of Qinghai University, Tongren Road 27, Xining, 810001, Qinghai, People’s Republic of China

    Manjun Deng, Zheheng Zhang, Zhixin Wang, Lingqiang Zhang, Li Ren & Haining Fan

  2. Qinghai Province Key Laboratory of Hydatid Disease Research, Xining, 810000, People’s Republic of China

    Manjun Deng, Zhixin Wang, Lingqiang Zhang, Li Ren & Haining Fan

  3. Department of Interventional Therapy, Affiliated Hospital of Qinghai University, Xining, 810001, People’s Republic of China

    Jingxin Yan

  4. Department of Postgraduate, Qinghai University, Xining, 810001, People’s Republic of China

    Jingxin Yan & Zheheng Zhang

Authors
  1. Manjun Deng
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jingxin Yan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zheheng Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Zhixin Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lingqiang Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Li Ren
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Haining Fan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MD: acquisition of data, analysis and interpretation of data, drafting the article, and final approval; JY and ZZ: acquisition of data, analysis and interpretation of data; ZW and LZ: resolve disagreement in data collection. LR and HF: revising the article conception and design of the study, critical revision, and final approval.

Corresponding authors

Correspondence to Li Ren or Haining Fan.

Ethics declarations

Conflict of interest

None of the authors have identified any conflicts of interest and financial disclosures.

Ethical approval

The article does not contain any studies with human participants or animals performed by any of the authors. Therefore, the paper is exempt from further Ethical Committee approval.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Deng, M., Yan, J., Zhang, Z. et al. Greater than or equal to 8 mm is a safe diameter of common bile duct for primary duct closure: single-arm meta-analysis and systematic review. Clin J Gastroenterol 15, 513–521 (2022). https://doi.org/10.1007/s12328-022-01615-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12328-022-01615-7

Keywords

Search

Navigation