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

Abstract

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.

Primary Closure Following Laparoscopic Common Bile Duct Reexploration for the Patients Who Underwent Prior Biliary Operation

“…In our last experience and some meta-analyses concluded that primary closure of the CBD was feasible and safe. Comparing primary closure with T-tube drainage during laparoscopic techniques showed a significant reduction in hospital stay and duration of operation with comparable complication rates [3,10,11]. In our setting, we achieved statistically significant shortening of the operating time and length of hospital stay together with recovery time of GI function for patients with primary closure versus those with T-tube drainage.…”

“…Biliary complication is a major criterion for measuring the safety of LCBDE with primary closure, the two major concerns were late bile duct stricture and bile leak [11]. Bile duct stricture following LCBDE was rare but with poor prognosis and regardless of whether the duct was explored via the transcystic or the trans-CBD route [15].…”

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

“…A prolonged operating time and duration of anesthesia are thought to be related to an increased risk of thromboembolic, respiratory, and cardiac complications, as suggested by Wu et al [30] in their meta-analysis.…”

“…To date four meta-analyses have been performed to compare the results of PDC with those of TTD [21,[29][30][31]. The most complete pooled analysis, performed by Yin et al [31], enrolled twelve studies (three randomized controlled trials and nine retrospective cohort studies) comparing PDC, with or without BD insertion, and TTD.…”

Laparoscopic transfistulous bile duct exploration for Mirizzi syndrome type II: a simplified standardized technique

“…Routine T-tube drainage has been shown related to increased complication rate following bile duct exploration [23,24], and the evoked foreign body reaction may lead to late biliary stricture. Bilioenteric bypass has been considered as the standard treatment for extensively destroyed bile duct in Csendes classification type IV [1,2,12].…”