T-tubevsno T-tube for biliary tract reconstruction in adult orthotopic liver transplantation: An updated systematic review and meta-analysis

Abstract

BACKGROUND Whether to use a T-tube for biliary anastomosis during orthotopic liver transplantation (OLT) remains a debatable question. Some surgeons chose to use a T-tube because they believed that it reduces the incidence of biliary strictures. Advances in surgical techniques during the last decades have significantly decreased the overall incidence of postoperative biliary complications. Whether using a T-tube during OLT is still associated with the reduced incidence of biliary strictures needs to be re-evaluated. AIM To provide an updated systematic review and meta-analysis on using a T-tube during adult OLT. METHODS In the electronic databases MEDLINE, PubMed, Scopus, ClinicalTrials.gov, the Cochrane Library, the Cochrane Hepato-Biliary Group Controlled Trails Register, and the Cochrane Central Register of Controlled Trials, we identified 17 studies (eight randomized controlled trials and nine comparative studies) from January 1995 to October 2020. The data of the studies before and after 2010 were separately extracted. We chose the overall biliary complications, bile leaks or fistulas, biliary strictures (anastomotic or non-anastomotic), and cholangitis as outcomes. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to describe the results of the outcomes. Furthermore, the test for overall effect (Z) was used to test the difference between OR and 1, where P ≤ 0.05 indicated a significant difference between OR value and 1. RESULTS A total of 1053 subjects before 2010 and 1346 subjects after 2010 were included in this meta-analysis. The pooled results showed that using a T-tube reduced the incidence of postoperative biliary strictures in studies before 2010 ( P = 0.012, OR = 0.62, 95%CI: 0.42-0.90), while the same benefit was not seen in studies after 2010 ( P = 0.60, OR = 0.76, 95%CI: 0.27-2.12). No significant difference in the incidence of overall biliary complications ( P = 0.37, OR = 1.41, 95%CI: 0.66-2.98), bile leaks ( P = 0.89, OR = 1.04, 95%CI: 0.63-1.70), and cholangitis ( P = 0.27, OR = 2.00, 95%CI: 0.59-6.84) was observed between using and not using a T-tube before 2010. However, using a T-tube appeared to increase the incidence of overall biliary complications ( P = 0.049, OR = 1.49, 95%CI: 1.00-2.22), bile leaks ( P = 0.048, OR = 1.91, 95%CI: 1.01-3.64), and cholangitis ( P = 0.02, OR = 7.21, 95%CI: 1.37-38.00) after 2010. A random-effects model was used in biliary strictures (after 2010), overall biliary complications (before 2010), and cholangitis (before 2010) due to their heterogeneity ( I 2 = 62.3%, 85.4%, and 53.6%, respectively). In the sensitivity analysis (only RCTs included), bile leak...

Post-Transplantation Cytomegalovirus Infection Interplays With the Development of Anastomotic Biliary Strictures After Liver Transplantation

“…In order to overcome the technical difficulty, using ductoplasty techniques or T-tube insertion was at the discretion of the surgeon. As previously shown, none of these technical refinements were associated with a reduced ABS rate ( 32 – 34 ).…”

Re-thinking of T-tube use in whole liver transplantation: an analysis on the risk of delayed graft function

“…A recent nationwide Italian survey [ 19 ] has reported that 25% of Italian LT Centers use it systematically, while 55% use it selectively; another international survey [ 20 ] has reported a 33.3% prevalence of T-tube use among LT Centers within the Eurotransplant, Swisstransplant, Scandiatransplant, and British Transplant Society networks. Several systematic review and meta-analysis [ 16 – 18 , 21 , 22 ] have shown that the overall use of T-tube does not significantly modify the risk of developing either biliary leak or stricture after DDLT. Even in the present study, the prevalence of biliary complications was decreased in the T-tube group, but not at a statistically significant level.…”

Post-Transplant Biliary Strictures: An Updated Review

“…36 A recent meta-analysis by Zhao et al concluded that there was not enough evidence to support routine T-tube placement during LT in adults for the prevention of biliary strictures. 37…”

“…Zhao et al demonstrated that the use of a T-tube did not reduce the incidence of AS yet appeared to increase the development of overall biliary complications, including cholangitis. 37 Because AS are unifocal, short-segment, and located within the extrahepatic bile duct, they are easily amenable to endoscopic therapy. Both endoscopic therapy and PTBD have similar initial success rates, but long-term recurrence rates may be higher with PTBD.…”