Can T-tube drainage be replaced by primary suture technique in laparoscopic common bile duct exploration? A meta-analysi
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SYSTEMATIC REVIEWS AND META-ANALYSES
Can T-tube drainage be replaced by primary suture technique in laparoscopic common bile duct exploration? A meta-analysis of randomized controlled trials Yuan Deng 1 & Hong-Wei Tian 1 & Lan-Juan He 2,3 & Yan Zhang 1 & Yuan-Hui Gu 1 & Yun-Tao Ma 1 Received: 25 July 2020 / Accepted: 22 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Although laparoscopic common bile duct exploration (LCBDE) is considered the best treatment and has the advantages of being minimally invasive for common bile duct (CBD) stones, the choice of T-tube drainage (TTD) or primary duct closure (PDC) after LCBDE is still controversial. Therefore, the aim of the study was to compare the superiority of PDC versus TTD after LCBDE for choledocholithiasis. Methods All potential studies which compare the surgical effects between PDC with TTD were electronically searched for in PubMed, Web of Science, and the Cochrane library databases up to November 2019. Data synthesis and statistical analysis were carried out using RevMan 5.3 software. Results In total, six randomized controlled trials with 604 patients (307 in the PDC group and 297 in the TTD group) were included in the current meta-analysis. As compared with the TTD group, the pooled data showed that PDC group had shorter operating time (WMD = −24.30; 95% CI = −27.02 to −21.59; p < 0.00001; I2 = 0%; p < 0.88), less medical expenditure (WMD = −2255.73; 95% CI = −3330.59 to −1180.86; p < 0.0001; I2 = 96%; p < 0.00001), shorter postoperative hospital stay (OR = −2.88; 95% CI = −3.22 to −2.54; p < 0.00001; I2 = 60%; p < 0.03), and lower postoperative complications (OR = 0.49; 95% CI = 0.31 to 0.78; p = 0.77; I2 = 0%; p = 0.003). There were no significant differences between the two groups concerning bile leakage (OR = 0.74; 95% CI = 0.36 to 1.53; p = 0.42; I2 = 0%; p = 0.90) and retained stones (OR = 0.96; 95% CI = 0.36 to 2.52; p < 0.93; I2 = 0%; p < 0.66). Conclusions LCBDE with PDC should be performed as a priority alternative compared with TTD for choledocholithiasis. Keywords Laparoscopic common bile duct exploration . Primary duct closure . T-tube drainage . Meta-analysis
Introduction Choledocholithiasis is a common and frequent disease in biliary surgery, which has become the second most frequent complication in patients with gallbladder stones [1]. Yuan Deng and Hong-Wei Tian contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00423-020-02000-z) contains supplementary material, which is available to authorized users. * Yun-Tao Ma [email protected] 1
Gansu Provincial Hospital, Lanzhou, China
2
Gansu University of Chinese Medicine, Lanzhou, China
3
Research Center Traditional Chinese Medicine, Gansu Province, Lanzhou, China
Approximately 10% to 18% of patients undergoing cholecystectomy for cholelithiasis have common bile duct (CBD) stones [2]. As we have known, choledocholithiasis can easily cause bile duct blockage, biliary c
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