Primary closure seems to be equally effective as T-tube drainage after laparoscopic common bile duct exploration

Gurusamy KS, Samraj K

Published Online:

January 21, 2009

Observational studies reach conflicting results on the use of T-tube drainage after laparoscopic common bile duct exploration of stones. Only one randomised trial of inadequate methodological quality has compared primary closure (27 patients) with T-tube drainage (28 patients) following laparoscopic exploration of the common bile duct for stones. There was no statistically significant difference in any of the outcomes between the T-tube group and the primary closure without biliary stent group except in the hospital stay. More randomised trials are necessary to assess the benefits and harms of T-tube drainage versus primary closure after laparoscopic common bile duct exploration.

Abstract (click to read)

Background:

Use of T-tube drainage after laparoscopic common bile duct exploration is controversial. We were unable to identify any meta-analysis or systematic reviews of the benefits and harms of T-tube drainage after common bile duct exploration.

Objectives:

To assess the benefits and harms of routine primary closure versus T-tube drainage following laparoscopic common bile duct stone exploration.

Search strategy:

We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until January 2006.

Selection criteria:

We considered for inclusion all randomised clinical trials comparing primary closure (with or without a biliary stent) versus T-tube drainage after laparoscopic common bile duct exploration.

Data collection and analysis:

We collected the data on the characteristics, methodological quality, mortality, morbidity, operating time, and hospital stay from the one identified trial. We analysed the data using the fixed-effect model using RevMan Analysis. For each outcome we calculated the odds ratio (OR) and weighted mean difference (WMD) with 95% confidence intervals based on intention-to-treat analysis.

Main results:

We included one trial with 55 patients randomised: 27 to the primary closure and 28 to the T-tube group. This trial was of inadequate methodological quality. There was no mortality in either group. There was no statistically significant difference between the two groups for any of the outcomes except for the hospital stay (WMD -2.8 days, 95% CI -1.93 to -3.67), which was lower in the primary closure group.

Authors' conclusions:

We have insufficient evidence to recommend T-tube drainage over primary closure after laparoscopic common bile duct stone exploration or vice versa. Further randomised trials are necessary to assess the benefits and harms of T-tube drainage compared with primary closure after laparoscopic common bile duct exploration.

This record should be cited as:

Gurusamy KS, Samraj K. Primary closure versus T-tube drainage after laparoscopic common bile duct stone exploration. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD005641. DOI: 10.1002/14651858.CD005641.pub2

Assessed as up to date:

September 13, 2006

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Primary Review Group:

Hepato-Biliary Group

Health topics:

Gastroenterology > Gall stone disease > Common bile duct-located

Gastroenterology > Gall stone disease > Gall bladder-located

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Primary closure seems to be equally effective as T-tube drainage after laparoscopic common bile duct exploration

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