Primary Suture Versus T-tube Drainage After Laparoscopic Common Bile Duct Exploration For Choledocholithiasis:Meta Analysis And Clinical Research

Objectives It is always be controversial on whether using primary suture or T-tube drainage after laparoscopic common bile duct exploration for patients with choledocholithiasis. There is no extensive clinical research focusing on this problem till now. The current systematic review and meta-analysis attempts to discuss on the benefits and harms of primary suture versus routine T-tube drainage in laparoscopic common bile duct exploration for choledocholithiasis.Methods A literature search of MEDLINE(Pubmed), EMBASE(Ovidsp), The Cochrane Library and Science Citation Index Expanded (Web of science) from January,1993to July,2013was done on the basis of the prior designed search strategy. We also reviewed the reference lists of retrieved articles. Selection of studies was conducted according to the eligibility and exclusion criteria. Quality evaluation of the research was carried out by The Cochrane Collaboration’s tool for assessing risk of bias and Jadad scale. We also apply the GRADE System on grading the quality of evidence and the strength of recommendations. Dichotomous data such as biliary complications, residual stones, the key factors affecting prognosis, wound infection and abdominal collections and continuous data like operating time and hospital stay were abstracted from all the chosen studies. The between-study heterogeneity was evaluated by Q statistic and I2statistic.Whether using random or fixed effects model to analyze the data was decided by heterogeneity. The summary statistic was tested by95%confidence interval(CI).The stability of the results was assessed by performing the sensitivity analysis. The funnel plot and the Egger’test were introduced to explore potential publication bias if possible. Results Three RCT on primary suture(without stent) versus T-tube drainage were included. Two of them were considered as high quality trails, the rest one was deemed as low quality. There was no statistically significant difference between two groups on biliary complications (RR95%CI,0.44(0.20,0.97), sidual stone (RR95%CI,1.27(0.32,5.07)), the key factors affecting prognosis (RR95%CI,0.57(0.29,1.10)), wound infection (RR95%CI,0.33(0.07,1.58)) and abdominal collections (RR95%CI,0.60(0.08,4.46)). The primary suture group had significantly lower operating time(WMD95%CI,-21.22(-30.00,-12.44)) and hospital stay (WMD95%CI,-3.26(-4.04,-2.49)). One RCT on primary suture(with stent) versus T-tube drainage was included. there was no statistically significant difference between two groups on biliary complications(RR95%CI,0.47(0.04,4.89)), residual stone (RR95%CI,0.31(0.01,7.38)), the key factors affecting prognosisand (RR95%CI,0.31(0.03,2.83)) and abdominal collections (RR95%CI,0.19(0.01,3.75)). The primary suture group had significantly lower operating time (WMD95%CI,-21.20(-30.70,-11.70)) and hospital stay (WMD95%CI,-3.26(-4.04,-2.49))Conclusions Primary suture of common bile duct after laparoscopic exploration seems as safe as T-tube drainage. Primary suture appears to result in significantly shorter operating time and hospital stay as compared with T-tube drainage. More high quality randomized trails aimed to compare the further advantage and harmful such as bile duct stricture and recurrence of common bile duct stones of primary suture with T-tube drainage should be performed to assess the further effect. Relevant randomized trails should be conducted to expolore the role of stent in primary suture. Objective To discuss the feasibility and clinical application value of placing ENBD during the operation of laparoscopic common bile duct exploration with primary closure of common bile duct.Methods We retrospectively analyzed145cases of choledocholithiasis treated with laparoscopic common bile duct exploration including94cases of placing ENBD with primary closure of common bile duct and51cases of T-tube drainage. Two groups were compared in operation time, intraoperative blood loss, postoperative hospital stay, postoperative intestinal function recovery time, removing abdominal cavity drainage tube time, bile drainage time and complications.Results The difference of two groups in operation time, intraoperative blood loss, removing abdominal cavity time, postoperative complications was not statistically significant(P>0.05).The difference in postoperative hospital stay, bowel function recovery time and bile drainage time was statistically significant(P<0.05).Conclusions On the basis of strictly surgical indications, application of placing ENBD during the operation of combined three endoscopes common bile duct exploration with primary closure of common bile duct is safe and feasible.