Skip to main content
SpringerLink
Log in

Systematic review with meta-analysis of studies comparing primary duct closure and T-tube drainage after laparoscopic common bile duct exploration for choledocholithiasis

  • Review
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

With advances in laparoscopic instrumentation and acquisition of advanced laparoscopic skills, laparoscopic common bile duct exploration (LCBDE) is technically feasible and increasingly practiced by surgeons worldwide. Traditional practice of suturing the dochotomy with T-tube drainage may be associated with T-tube-related complications. Primary duct closure (PDC) without a T-tube has been proposed as an alternative to T-tube placement (TTD) after LCBDE. The aim of this meta-analysis was to evaluate the safety and effectiveness of PDC when compared to TTD after LCBDE for choledocholithiasis.

Methods

A systematic literature search was performed using PubMed, EMBASE, MEDLINE, Google Scholar, and the Cochrane Central Register of Controlled Trials databases for studies comparing primary duct closure and T-tube drainage. Studies were reviewed for the primary outcome measures: overall postoperative complications, postoperative biliary-specific complications, re-interventions, and postoperative hospital stay. Secondary outcomes assessed were: operating time, median hospital expenses, and general complications.

Results

Sixteen studies comparing PDC and TTD qualified for inclusion in our meta-analysis, with a total of 1770 patients. PDC showed significantly better results when compared to TTD in terms of postoperative biliary peritonitis (OR 0.22, 95 % CI 0.06–0.76, P = 0.02), operating time (WMD, −22.27, 95 % CI −33.26 to −11.28, P < 0.00001), postoperative hospital stay (WMD, −3.22; 95 % CI −4.52 to −1.92, P < 0.00001), and median hospital expenses (SMD, −1.37, 95 % CI −1.96 to −0.77, P < 0.00001). Postoperative hospital stay was significantly decreased in the primary duct closure with internal biliary drainage (PDC + BD) group when compared to TTD group (WMD, −2.68; 95 % CI −3.23 to −2.13, P < 0.00001).

Conclusions

This comprehensive meta-analysis demonstrates that PDC after LCBDE is feasible and associated with fewer complications than TTD. Based on these results, primary duct closure may be considered as the optimal procedure for dochotomy closure after 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

Similar content being viewed by others

References

  1. Collins C, Maguire D, Ireland A, Fitzgerald E, O’Sullivan GC (2004) A prospective study of common bile duct calculi in patients undergoing laparoscopic cholecystectomy: natural history of choledocholithiasis revisited. Ann Surg 239:28–33

    Article  PubMed Central  PubMed  Google Scholar 

  2. Williams EJ, Green J, Beckingham I, Parks R, Martin D, Lombard M, British Society of Gastroenterology (2008) Guidelines on the management of common bile duct stones (CBDS). Gut 57:1004–1021

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  4. Martin IJ, Bailey IS, Rhodes M, O’Rourke N, Nathanson L, Fielding G (1998) Towards T-tube free laparoscopic bile duct exploration: a methodologic evolution during 300 consecutive procedures. Ann Surg 228:29–34

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  5. Millat B, Atger J, Deleuze A, Briandet H, Fingerhut A, Guillon F, Marrel E, De Seguin C, Soulier P (1997) Laparoscopic treatment for choledocholithiasis: a prospective evaluation in 247 consecutive unselected patients. Hepatogastroenterology 44:28–34

    CAS  PubMed  Google Scholar 

  6. Cuschieri A, Lezoche E, Morino M, Croce E, Lacy A, Toouli J, Faggioni A, Ribeiro VM, Jakimowicz J, Visa J, Hanna GB (1999) E.A.E.S multicenter prospective randomized trial comparing two-stage vs single stage management of patients with gallstone disease and ductal calculi. Surg Endosc 13:952–957

    Article  CAS  PubMed  Google Scholar 

  7. Ding G, Cai W, Qin M (2014) Single-stage vs. two stage management for concomitant gallstones and common bile duct stones: a prospective randomized trial with long-term follow-up. J Gastrointest Surg 18:947–951

    Article  PubMed  Google Scholar 

  8. Rhodes M, Sussman L, Cohen L, Lewis MP (1998) Randomised trial of laparoscopic exploration of common bile duct versus postoperative endoscopic retrograde cholangiography for common bile duct stones. Lancet 351:159–161

    Article  CAS  PubMed  Google Scholar 

  9. Lyass S, Phillips EH (2006) Laparoscopic transcystic duct common bile duct exploration. Surg Endosc 20(Suppl 2):S441–S445

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  11. Williams JA, Treacy PJ, Sidey P, Worthley CS, Townsend NC, Russell EA (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 

  12. Isla AM, Griniatsos J, Karvounis E, Arbuckle JD (2004) Advantages of laparoscopic stented choledochorrhaphy over T-tube placement. Br J Surg 91:862–866

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  14. Ahmed M, Diggory RT (2013) Case-based review: bile peritonitis after T-tube removal. Ann R Coll Surg Engl 95:383–385

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  15. 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 

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

    CAS  PubMed  Google Scholar 

  17. Zhang HW, Chen YJ, Wu CH, Li WD (2014) Laparoscopic common bile duct exploration with primary closure for management of choledocholithiasis: a retrospective analysis and comparison with conventional T-tube drainage. Am Surg 80:178–181

    PubMed  Google Scholar 

  18. Dong ZT, Wu GZ, Luo KL, Li JM (2014) Primary closure after laparoscopic common bile duct exploration versus T-tube. J Surg Res 189:249–254

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  20. Gurusamy KS, Koti R, Davidson BR (2013) Primary closure versus T-tube drainage after open common bile duct exploration. Cochrane Database Syst Rev 6:CD005640. doi:10.1002/14651858.CD005640.pub3

    PubMed  Google Scholar 

  21. Gurusamy KS, Koti R, Davidson BR (2013) Primary closure versus T-tube drainage after laparoscopic common bile duct exploration. Cochrane Database Syst Rev 6:CD005641. doi:10.1002/14651858.CD005641.pub3

    PubMed  Google Scholar 

  22. Kim EK, Lee SK (2004) Laparoscopic treatment of choledocholithiasis using modified biliary stents. Surg Endosc 18:303–306

    Article  CAS  PubMed  Google Scholar 

  23. Griniatsos J, Karvounis E, Arbuckle J, Isla AM (2005) Cost-effective method for laparoscopic choledochotomy. ANZ J Surg 75:35–38

    Article  PubMed  Google Scholar 

  24. Wei Q, Hu HJ, Cai XY, Li LB, Wang GY (2004) Biliary drainage after laparoscopic choledochotomy. World J Gastroenterol 10:3175–3178

    Article  PubMed Central  PubMed  Google Scholar 

  25. Tang CN, Tai CK, Ha JP, Tsui KK, Wong DC, Li MK (2006) Antegrade biliary stenting versus T-tube drainage after laparoscopic choledochotomy. A comparative cohort study. Hepatogastroenterology 53:330–334

    CAS  PubMed  Google Scholar 

  26. Kanamaru T, Sakata K, Nakamura Y, Yamamoto M, Ueno N, Takeyama Y (2007) Laparoscopic choledochotomy in management of choledocholithiasis. Surg Laparosc Endosc Percutan Tech 17:262–266

    Article  PubMed  Google Scholar 

  27. Martinez-Baena D, Parra-Membrives P, Diaz-Gomez D, Lorente-Herce JM (2013) Laparoscopic common bile duct exploration and antegrade biliary stenting: leaving behind the Kehr tube. Rev Esp Enferm Dig 105:125–129

    Article  PubMed  Google Scholar 

  28. Mangla V, Chander J, Vindal A, Lal P, Ramteke VK (2012) A randomized trial comparing the use of endobiliary stent and T-tube for biliary decompression after laparoscopic common bile duct exploration. Surg Laparosc Endosc Percutan Tech 22:345–348

    Article  PubMed  Google Scholar 

  29. Zhu QD, Tao CL, Zhou MT, Yu ZP, Shi HQ, Zhang QY (2011) Primary closure versus T-tube drainage after common bile duct exploration for choledocholithiasis. Langenbecks Arch Surg 396:53–62

    Article  PubMed  Google Scholar 

  30. Wu X, Yang Y, Dong P, Gu J, Lu J, Li M, Mu J, Wu W, Yang J, Zhang L, Ding Q, Liu Y (2012) 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

    Article  PubMed  Google Scholar 

  31. Yin Z, Xu K, Sun J, Zhang J, Xiao Z, Wang J, Niu H, Zhao Q, Lin S, Li Y (2013) Is the end of the T-tube drainage era in laparoscopic choledochotomy for common bile duct stones is coming? A systematic review and meta-analysis. Ann Surg 257:54–66

    Article  PubMed  Google Scholar 

  32. Cai H, Sun D, Sun Y, Bai J, Zhao H, Miao Y (2012) Primary closure following laparoscopic common bile duct exploration combined with intraoperative cholangiography and choledochoscopy. World J Surg 36:164–170

    Article  PubMed  Google Scholar 

  33. Morcillo IA, Qurashi K, Carrion JA, Isla AM (2014) Laparoscopic common bile duct exploration. Lessons learned after 200 cases. Cir Esp 92:341–347

    Article  Google Scholar 

  34. Higgins JP, Green S (2011) Cochrane handbook for systematic reviews of interventions, version 5.1.0. The Cochrane collaboration. http://www.cochrane-handbook.org

  35. Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P (2013) The Newcastle–Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp

  36. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. Ann Intern Med 151:W65–W94

    Article  PubMed  Google Scholar 

  37. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188

    Article  CAS  PubMed  Google Scholar 

  38. Review Manager (RevMan) [computer program]. Version 5.3.5, 2014. The Nordic Cochrane Centre, Cochrane Collaboration, www.cochrane-handbook.org

  39. Zhang WJ, Xu GF, Wu GZ, Li JM, Dong ZT, Mo XD (2009) Laparoscopic exploration of common bile duct with primary closure versus T-tube drainage: a randomized clinical trial. J Surg Res 157:1–5

    Article  Google Scholar 

  40. Huang SM, Yao CC, Cheng YW, Chen LY, Pan H, Hsiao KM, Yang MD, Wu CW, Lui WY, Lai TJ (2010) Laparoscopic primary closure of common bile duct combined with percutaneous cholangiographic drainage for treating choledocholithiasis. Am Surg 76:517–521

    PubMed  Google Scholar 

  41. (in Japanese)

    CAS  PubMed  Google Scholar 

  42. Ryan R (2013) Cochrane Consumers and Communication Review Group: meta-analysis. http://cccrg.cochrane.org

  43. Coppola R, Riccioni ME, Ciletti S, Cosentino L, Coco C, Magistrelli P, Picciocchi A (1997) Analysis of complications of endoscopic sphincterotomy for biliary stones in a consecutive series of 546 patients. Surg Endosc 11:129–132

    Article  CAS  PubMed  Google Scholar 

  44. Lu J, Xiong XZ, Cheng Y, Lin YX, Zhou RX, You Z, Wu SJ, Cheng NS (2013) One stage versus two-stage management for concomitant gallbladder stones and common bile duct stones in patients with obstructive jaundice. Am Surg 79:1142–1148

    PubMed  Google Scholar 

  45. Li MK, Tang CN, Lai EC (2011) Managing concomitant gallbladder stones and common bile duct stones in the laparoscopic era: a systematic review. Asian J Endosc Surg 4:53–58

    Article  CAS  PubMed  Google Scholar 

  46. Bansal VK, Misra MC, Rajan K, Kilambi R, Kumar S, Krishna A, Kumar A, Pandav CS, Subramaniam R, Arora MK, Garg PK (2014) Single-stage laparoscopic common bile duct exploration and cholecystectomy versus two-stage endoscopic stone extraction followed by laparoscopic cholecystectomy for patients with concomitant gallbladder stones and common bile duct stones: a randomized controlled trial. Surg Endosc 28:875–885

    Article  PubMed  Google Scholar 

  47. Patelin JB (2003) Laparoscopic common bile duct exploration. Lessons learned from >12 years’ experience. Surg Endosc 17:1705–1715

    Article  Google Scholar 

  48. Khaled YS, Malde DJ, de Souza C, Kalia A, Ammori BJ (2013) Laparoscopic bile duct exploration via choledochotomy followed by primary duct closure is feasible and safe for the treatment of choledocholithiasis. Surg Endosc 27:4164–4170

    Article  PubMed  Google Scholar 

  49. Taylor CJ, Kong J, Ghusn M, White S, Crampton N, Layani L (2007) Laparoscopic bile duct exploration: results of 160 consecutive cases with 2-year follow-up. ANZ J Surg 77:440–445

    Article  PubMed  Google Scholar 

  50. Decker G, Borie F, Millat B, Berthou JC, Deleuze A, Drouard F, Guillon F, Rodier JG, Fingerhut A (2003) One hundred laparoscopic choledochotomies with primary closure of the common bile duct. Surg Endosc 17:12–18

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  52. Gigot JF, Navez B, Etienne J, Cambier E, Jadoul P, Guiot P, Kestens PJ (1997) A stratified intraoperative surgical strategy is mandatory during laparoscopic common bile duct exploration for common bile duct stones. Lessons and limits from an initial experience of 92 patients. Surg Endosc 11:722–728

    Article  CAS  PubMed  Google Scholar 

  53. Uchiyama K, Onishi H, Tani M, Kinoshita H, Kawai M, Ueno M, Yamaue H (2003) Long-term prognosis after treatment of patients with choledocholithiasis. Ann Surg 238:97–102

    PubMed Central  PubMed  Google Scholar 

  54. Schreurs WH, Juttmann JR, Stuifbergen WN, Oostvogel HJ, van Vroonhoven TJ (2002) Management of common bile duct stones: selective endoscopic retrograde cholangiography and endoscopic sphincterotomy: short- and long-term results. Surg Endosc 16:1068–1072

    Article  CAS  PubMed  Google Scholar 

  55. Paganini AM, Guerrieri M, Sarnari J, De Sanctis A, D’Ambrosio G, Lezoche G, Perretta S, Lezoche E (2007) Thirteen years’ experience with laparoscopic transcystic common bile duct exploration for stones. Effectiveness and long-term results. Surg Endosc 21:34–40

    Article  CAS  PubMed  Google Scholar 

Download references

Disclosures

Mauro Podda, Francesco Maria Polignano, Andreas Luhmann, Michael Samuel James Wilson, Christoph Kulli, Iain Stephen Tait, have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. HPB and UpperGI Surgery Unit, Ninewells Hospital and Medical School, Ward 11, Dundee, DD1 9SY, UK

    Mauro Podda, Francesco Maria Polignano, Andreas Luhmann, Michael Samuel James Wilson, Christoph Kulli & Iain Stephen Tait

Authors
  1. Mauro Podda
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Francesco Maria Polignano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andreas Luhmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michael Samuel James Wilson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christoph Kulli
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Iain Stephen Tait
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mauro Podda.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Podda, M., Polignano, F.M., 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 30, 845–861 (2016). https://doi.org/10.1007/s00464-015-4303-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-015-4303-x

Keywords

Search

Navigation