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

Podda, Mauro; Polignano, Francesco M.; Luhmann, Andreas; Wilson, Michael; Kulli, Christoph; Tait, Iain S.

doi:10.1007/s00464-015-4303-x

Cited by 98 publications

(90 citation statements)

References 51 publications

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“…Several comparative studies and meta-analysis have demonstrated that primary closure is at least as effective and safe as T-tube drainage [8, 34, 35], even in emergency operation [36] and elderly patients [37]. Long-term outcome also shown that primary closure after LCBDE had a low incidence of recurrent stones, and no biliary strictures [5].…”

Section: Discussionmentioning

confidence: 99%

Risk factors for bile leakage after primary closure following laparoscopic common bile duct exploration: a retrospective cohort study

et al. 2017

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AbstractionBackgroundPrimary closure following laparoscopic common bile duct exploration (LCBDE) has been widely adopted because of the efficacy and safety in treatment of common bile duct (CBD) stones. However, the risk factors for bile leakage, the most common complication after primary closure, has not been clarified yet.MethodsA retrospective cohort study of patients who underwent LCBDE with primary closure after choledochotomy between Feb. 2012 and Jun. 2016 was performed. Risk factors for bile leakage were identified by logistic regression inculding demographic factors, preoperative condition and surgical details.ResultsBetween Feb. 2012 and Jun. 2016, a total of 265 LCBDE procedures were applied in our hospital and 141 patients with primary closure were included in this study. Bile leakage occurred in 11.3% (16/141) of these patients, and happened more frequently in patients with slender CBD (<1 vs ≥1 cm, 31.6% vs 7.0%, p = 0.04) and those managed by inexperienced surgeons (initial 70 cases vs later cases, 17.1% vs 5.6%, p = 0.04). After multivariable regression, the diameter of CBD [OR 95% CI, 3.799 (1.081–13.349), p = 0.04] and experience of surgeons [OR 95% CI, 4.228 (1.330–13.438), p = 0.03] were significantly related to bile leakage.ConclusionSlender CBD and inexperienced surgeons were the high risk factors for bile leakage after primary closure following LCBDE.

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Section: Discussionmentioning

confidence: 99%

Risk factors for bile leakage after primary closure following laparoscopic common bile duct exploration: a retrospective cohort study

et al. 2017

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“…These injuries are usually recognized with cholangiography; thus, only the small incision used to insert the cholangiocatheter needs to be repaired. Insertion of a T-tube catheter is rather contraindicated, as extension of the laceration to facilitate T-tube insertion results in worsening of the injury and an increased risk of stricture [66]. We recommend suturing the incision using simple interrupted stitches.…”

Section: Class I Injuriesmentioning

confidence: 99%

Bile Duct Injury after Cholecystectomy: Surgical Therapy

Renz¹,

Bösch²,

Angele³

2017

Visc Med

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Background: Iatrogenic bile duct injuries (IBDI) after laparoscopic cholecystectomy (LC), being one of the most common performed surgical procedures, remain a substantial problem in gastrointestinal surgery. The most important aspect regarding this issue is the prevention of IBDI during index cholecystectomy. Once it occurs, early and accurate diagnosis of IBDI is very important for surgeons and gastroenterologists, because unidentified IBDI may result in severe complications such as hepatic failure and death. Laboratory tests, radiological imaging, and endoscopy play an important role in the diagnosis of biliary injuries. Methods: This review summarizes and discusses the current literature on the management of IBDI after LC from a surgical point of view. Results and Conclusion: In general, endoscopic techniques are recommended for the initial diagnosis and treatment of IBDI and are important to classify them correctly. In patients with complete dissection or obstruction of the bile duct, surgical management remains the only feasible option. Different surgical reconstructions are performed in patients with IBDI. According to the available literature, Roux-en-Y hepaticojejunostomy is the most frequent surgical reconstruction and is recommended by most authors. Long-term results are most important in the assessment of effectiveness of IBDI treatment. Apart from that, adequate diagnosis and treatment of IBDI may avoid many serious complications and improve the quality of life of our patients.

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“…Laparoscopic choledocholithotomy with primary bile duct closure has been reported to be safe compared with T‐tube insertion . Podda et al demonstrated that primary bile duct closure after laparoscopic choledocholithotomy had fewer complications than T‐tube insertion . Retained stones occurred in 1.3% of 444 patients after primary bile duct closure and in 1.4% of 414 patients after T‐tube insertion .…”

Section: Discussionmentioning

confidence: 99%

“…There are various treatment options for removing BDS. Although the best strategy for removing BDS remains controversial, the options include duodenal endoscopic sphincterotomy (EST), laparoscopic or open choledocholithotomy via the transcystic approach or choledochotomy, and primary closure of the bile duct or T‐tube drainage . The size and location of the BDS, the size of the extrahepatic bile duct, and patients' general health affect the treatment choice.…”

Section: Introductionmentioning

confidence: 99%

Safety and efficacy of a novel continuous incision technique for laparoscopic transcystic choledocholithotomy

Otani

Yokoyama

Sato

et al. 2017

Asian J Endoscop Surgery

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

Abstract: 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.

Cited by 98 publications

References 51 publications

Risk factors for bile leakage after primary closure following laparoscopic common bile duct exploration: a retrospective cohort study

Risk factors for bile leakage after primary closure following laparoscopic common bile duct exploration: a retrospective cohort study

Bile Duct Injury after Cholecystectomy: Surgical Therapy

Safety and efficacy of a novel continuous incision technique for laparoscopic transcystic choledocholithotomy

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