Primary Closure Versus T-Tube Drainage After Laporoscopic Common Bile Duct Exploration:A Systematic Review

Objective:To assess the clinical efficacy and complications of T-tube drainage versus primary closure after laparoscopic common bile duct exploration,including operation time,duration of hospital stay,incidence of peritonitis,incidence of residual stones,incidence of biliary bleeding,incidence of biliary leakage,incidence of obstructive jaundice and pancreatitis,incidence of incisional infection and incidence of general complications after operation.Methods: A systematic literature search was performed using PubMed,EMBASE,Cochrane Library,and CNKI databases.All the studies at home and abroad comparing primary closure and T-tube drainage after laparoscopic common bile duct exploration were collected from September 1,2003 to September 1,2018.The quality of the randomized controlled trials were evalued.According to inclusion criteria and exclusion criteria,11 randomized controlled studies were included.RevMan 5.3 software was used for the statistical analysis.Results: We included 11 trials randomising 1033 participants: 513 to T-tube drainage versus 520 to primary closure.Ten randomized controlled studies provided data on operation time:[MD=-15.73,95%CI=[-21.85,-9.60];The result revealed that primary closure can shorten the operation time.Seven studies in total were related to the duration of hospital stay with the result of:[MD=-3.30,95%CI=[-4.52,-2.08],Z=5.32(P<0.00001)].The result revealed that primary closure can also shorten the duration of hospital stay.Nine studies provided data on the incidence of general complications with the result of:[OR=0.37,95%CI=[0.25,0.56],Z=4.71(P<0.00001)].Compared with the T-tube drainage,the data show less complications in primary closure.Six studies compared the incidence of obstructive jaundice after operation with the result of:[OR=0.20,95%CI=[0.06,0.70],Z=2.51(P=0.01)],indicating that primary closure has lower incidence of obstructive jaundice after operation compared with T-tube drainage.Ten studies compared the incidence of biliary leakage after operation:[OR=0.37,95%CI=[0.21,0.66],Z=3.35(P=0.0008)].The result also favored the primary closure group.No significant differences were found in the incidence of residual stones,biliary bleeding,incisional infection and pancreatitis after operation(P=0.51,P=0.75,P=0.16,P=0.97).Conclusions: This meta-analysis indicates that LCBDE with primary closure is feasible and safe under the premise of grasping surgical indication.Comparing with T-tube drainage,primary closure has shorter operation time and hospital stay,and lower incidence of postoperative biliary leakage,obstructive jaundice and general complications.However,more multicenter,large sample size,high quality clinical randomized controlled trails should be conducted to clarify this issue due to the poor quality of the included literatures.