Skip to main content
SpringerLink
Log in

Primary closure versus T-tube drainage in laparoscopic common bile duct exploration: a meta-analysis of randomized clinical trials

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

Abstract

Purpose

To compare the safety and effectiveness of primary closure with those of T-tube drainage in laparoscopic common bile duct exploration (LCBDE) for choledocholithiasis.

Methods

A comprehensive search was performed in the PubMed, EmBase, and Cochrane Library databases. Only randomized controlled trials comparing primary closure with T-tube drainage in LCBDE were considered eligible for this meta-analysis. The analyzed outcome variables included postoperative mortality, overall morbidity, biliary complication rate, biliary leak rate, reoperation, operating time, postoperative hospital stay, time to abdominal drain removal, and retained stone. All calculations and statistical tests were performed using ReviewerManager 5.1.2 software.

Results

A total of 295 patients (148 patients with primary closure and 147 patients with T-tube drainage) from three trials were identified and analyzed. No deaths occurred in any of the trials. Primary closure showed significantly better results in terms of morbidity (risk ratio (RR), 0.51; 95% confidence interval (CI), 0.30 to 0.88), biliary complication without a combination of retained stone (RR, 0.44; 95% CI, 0.20 to 0.97), reoperation (RR, 0.16; 95% CI, 0.03 to 0.87), operating time (mean difference (MD), −20.72; 95% CI, −29.59 to −11.85), postoperative hospital stay (MD, −3.24; 95% CI, −3.96 to −2.52), and time to abdominal drainage removal (MD, −0.45; 95% CI, −0.86 to −0.04). Statistically significant differences were not found between the two methods in terms of biliary leak, biliary complication, and retained stones.

Conclusion

The current meta-analysis indicates that primary closure of the common bile duct is safer and more effective than T-tube drainage for LCBDE. Therefore, we do not recommend routine performance of T-tube drainage in LCBDE.

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

Similar content being viewed by others

References

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

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  4. Rhodes M, Sussman L, Cohen L et al (1998) Randomized trial of laparoscopic exploration of common bile duct versus postoperative endoscopic retrograde cholangiography for common bile duct stones. Lancet 351:159–161

    Article  PubMed  CAS  Google Scholar 

  5. Noble H, Tranter S, Chesworth T et al (2009) A randomized, clinical trial to compare endoscopic sphincterotomy and subsequent laparoscopic cholecystectomy with primary laparoscopic bile duct exploration during cholecystectomy in higher risk patients with choledocholithiasis. J Laparoendosc Adv Surg Tech A 19:713–720

    Article  PubMed  Google Scholar 

  6. Rogers SJ, Cello JP, Horn JK et al (2010) Prospective randomized trial of LC+LCBDE vs ERCP/S+LC for common bile duct stone disease. Arch Surg 145:28–33

    Article  PubMed  Google Scholar 

  7. Wills VL, Gibson K, Karihaloo C et al (2002) Complications of biliary T-tubes after choledochotomy. ANZ J Surg 72:177–180

    Article  PubMed  Google Scholar 

  8. El-Geidie AA (2010) Is the use of T-tube necessary after laparoscopic choledochotomy? J Gastrointest Surg 14:844–848

    Article  PubMed  Google Scholar 

  9. Zhang L, Bie P, Wang S et al (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 

  10. 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 

  11. Gurusamy KS, Samraj K (2007) Primary closure versus T-tube drainage after open common bile duct exploration. Cochrane Database Syst Rev 24(1):CD005640

    Google Scholar 

  12. 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  PubMed  CAS  Google Scholar 

  13. Lefebvre C, Manheimer E, Glanville J (2011) Chapter 6: searching for studies. In: Higgins JPT, Green S (eds). Cochrane handbook for systematic reviews of interventions version 5.1.0 (updated March 2011). The Cochrane Collaboration, Available from www.cochrane-handbook.org

  14. Higgins JPT, Altman DG, Sterne JAC (eds) (2011) Chapter 8: assessing risk of bias in included studies. In: Higgins JPT, Green S (eds). Cochrane handbook for systematic reviews of interventions version 5.1.0 (updated March 2011). The Cochrane Collaboration. Available from www.cochrane-handbook.org

  15. Deeks JJ, Higgins JPT, Altman DG (eds) (2011) Chapter 9: analysing data and undertaking meta-analyses. In: Higgins JPT, Green S (eds). Cochrane handbook for systematic reviews of interventions version 5.1.0 (updated March 2011). The Cochrane Collaboration. Available from www.cochrane-handbook.org

  16. 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–e5

    Article  PubMed  Google Scholar 

  17. O’Rourke NA, Askew AR, Cowen AE et al (1993) The role of ERCP and endoscopic sphincterotomy in the era of laparoscopic cholecystectomy. ANZ J Surg 63:3–7

    Article  Google Scholar 

  18. Tanaka M, Konomi H, Matsunaga H et al (1997) Endoscopic sphincterotomy for common bile duct stones: impact of recent technical refinements. J Hepatobiliary Pancreat Surg 4:16–19

    Article  Google Scholar 

  19. Binmoeller KF, Schafer TW (2001) Endoscopic management of bile duct stones. J Clin Gastroenterol 32:106–118

    Article  PubMed  CAS  Google Scholar 

  20. Coppola R, Riccioni ME, Ciletti S et al (1997) Analysis of complications of endoscopic sphincterotomy for biliary stones in a consecutive series of 546 patients. Surg Endosc 11:129–132

    Article  PubMed  CAS  Google Scholar 

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

    PubMed  Google Scholar 

  22. Martin DJ, Vernon DR, Toouli J (2006) Surgical versus endoscopic treatment of bile duct stones. Cochrane Database Syst Rev CD003327

  23. Holdsworth RJ, Sadek SA, Ambikar S et al (1989) Dynamics of bile flow through the human choledochal sphincter following exploration of the common bile duct. World J Surg 13:300–306

    Article  PubMed  CAS  Google Scholar 

  24. 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 

  25. Martin IJ, Bailey IS, Rhodes M et al (1998) Towards T-tube-free laparoscopic bile duct exploration: a methodological evolution during 300 consecutive procedures. Ann Surg 228:29

    Article  PubMed  CAS  Google Scholar 

  26. Cuschieri A, Croce E, Faggioni A et al (1996) WEAES ductal stone study. Preliminary findings of multicenter prospective randomized trial comparing two-stage versus single-stage management. Surg Endosc 10:1130

    Article  PubMed  CAS  Google Scholar 

  27. Wills VL, Gibson K, Karihaloot C et al (2002) Complications of biliary T-tubes after choledochotomy. ANZ J Surg 72:177–180

    Article  PubMed  Google Scholar 

  28. Lezoche E, Paganini AM, Guerrieri M (1996) A new T-tube applier in laparoscopic surgery. Surg Endosc 10:445–448

    Article  PubMed  CAS  Google Scholar 

  29. Kumar P, Orizu M, Leung E (2009) Laparoscopic T-tube placement after common bile duct exploration: a simple technique. Surg Laparosc Endosc Percutan Tech 19:e36–e37

    Article  PubMed  Google Scholar 

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

  31. Ha JP, Tang CN, Siu WT et al (2004) Primary closure versus T-tube drainage after laparoscopic choledochotomy for common bile duct stones. Hepatogastroenterology 51:1605–1608

    PubMed  CAS  Google Scholar 

  32. Jameel M, Darmas B, Baker AL (2008) Trend towards primary closure following laparoscopic exploration of the common bile duct. Ann R Coll Surg Engl 90:29–35

    Article  PubMed  CAS  Google Scholar 

  33. Zhu QD, Tao CL, Zhou MT et al (2011) Primary closure versus T-tube drainage after common bile duct exploration for choledocholithiasis. Langenbecks Arch Surg 396:53–62

    Article  PubMed  Google Scholar 

  34. Koch M, Garden OJ, Padbury R et al (2011) Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery 149:680–688

    Article  PubMed  Google Scholar 

  35. Egger M, Smith GD (1997) Meta-analysis. Potentials and promise. BMJ 315:1371–1374

    Article  PubMed  CAS  Google Scholar 

  36. Mulrow CD (1994) Rationale for systematic reviews. BMJ 309:597–599

    Article  PubMed  CAS  Google Scholar 

  37. Egger M, Davey Smith G, Schneider M et al (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634

    Article  PubMed  CAS  Google Scholar 

Download references

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of General Surgery, Xinhua Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China

    Xiangsong Wu, Yong Yang, Ping Dong, Jun Gu, Jianhua Lu, Maolan Li, Jiasheng Mu, Wenguang Wu, Jiahua Yang, Lin Zhang, Qichen Ding & Yingbin Liu

Authors
  1. Xiangsong Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yong Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ping Dong
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jun Gu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jianhua Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Maolan Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jiasheng Mu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Wenguang Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jiahua Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Lin Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Qichen Ding
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Yingbin Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yingbin Liu.

Rights and permissions

Reprints and permissions

About this article

Cite this article

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 397, 909–916 (2012). https://doi.org/10.1007/s00423-012-0962-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-012-0962-4

Keywords

Search

Navigation