Primary Duct Closure Versus T-Tube Drainage After Laparoscopic Common Bile Duct Exploration:a Meta-Analysis

BackgroundCholedocholithiasis,which is always concurrent with acute cholangitis,is one of the common acute abdomen in general surgery.Patients usually manifest as acute biliary obstruction and varying degrees of inflammation.Nowadays,laparoscopic common bile duct exploration(LCBDE)has gradually replaced open common bile duct exploration as the first choice for surgical treatment of common bile duct stones(CBDS).T-tube is routinely placed after common bile duct incision and exploration,which plays the role of mechanical support to prevent bile duct stricture.At the same time,when stones remain or recur,T-tube can be used as a channel for cholangiography,choledochoscopy and stone extraction.However,some studies believe that primary suture of bile duct is safe,which not only does not increase the risk of postoperative complications,but also can avoid the adverse experience and complications caused by T-tube drainage.Whether conventional indwelling T tube or primary suture after laparoscopic common bile duct exploration for common bile duct stones is still controversial.ObjectiveTo evaluate the operative complications and health economic indexes of primary duct closure(PDC)versus T tube drainage(TTD)after laparoscopic common bile duct exploration for common bile duct stone.MethodsThe randomized controlled trials of PDC and TTD after LCBDE for CBDS were retrieved from the Cochrane Library,Pubmed,Web of science,CNKI,Wanfang Data and CBM from January 1,2005 to December 31,2021.The quality of literature was evaluated according to the Cochrane systematic evaluation method,and meta-analysis was carried out by Review Manager 5.2 software.ResultsA total of 4435 patients from 49 studies,which are all randomized controlled trials,were included.The result of meta-analysis shows that the incidence of bile leakage of PDC group was less than that of TTD group(OR=0.59,95%CI:0.44～0.79,P<0.01).There was no significant difference in the incidence of biliary stricture between the two groups(OR=0.87,95%CI:0.33～2.29,P=0.78).The incidence of recurrence of CBDS or residual stone of PDC group was less than that of TTD group(OR=0.58,95%CI:0.37～0.90,P=0.02).About the comparison of the health economic indexes between the two groups,the operation time of PDC group was shorter than that of TTD group(WMD=-14.35,95%CI:-23.99～-4.71,P<0.01).The total hospital stay of PDC group was shorter than that of TTD group(WMD=-3.78,95%CI:-4.34～-3.22,P<0.01).The intraoperative blood loss of PDC group was less than that of TTD group(WMD=-5.75,95%CI:-9.85～-1.64,P<0.01).The hospital expenses of PDC group was less than that of TTD group(WMD=-3.14,95%CI:-4.12～-2.16,P<0.01).ConclusionAfter LCBDE for choledocholithiasis without biliary stricture,sphincter of Oddi dysfunction,acute pancreatitis,acute obstructive suppurative cholangitis and bile duct tumor,primary duct closure is more effective than T-tube drainage.For PDC,the incidence of bile leakage and the residual or recurrence rate of common bile duct stone are lower,and there is no significant difference in the incidence of biliary stricture.PDC is a safe and effective treatment,which can shorten the operation time and hospitalization time,reduce surgical bleeding and hospitalization costs,and has certain health and economic benefits.