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Erschienen in:
01.01.2011 | Original Article
Primary closure versus T-tube drainage after common bile duct exploration for choledocholithiasis
Erschienen in: Langenbeck's Archives of Surgery | Ausgabe 1/2011
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Purpose
The aim of this study was to evaluate the benefits and harms of primary closure versus T-tube drainage after common bile duct (CBD) exploration for choledocholithiasis.
Methods
A literature search of MEDLINE (PubMed), EMBASE, and the Cochrane Library was done to identify randomized controlled trials assessing the benefits and harms of primary closure versus T-tube drainage after CBD exploration from Jan. 1990 to Apr. 2010. A meta-analysis was set up to distinguish overall difference between the primary closure and the T-tube drainage group.
Results
There were statistically significant differences between groups: biliary complications (odds ratio (OR) 95% confidence interval (CI), 0.42 (0.19–0.92); P = 0.03), main complications (OR 95% CI, 0.46 (0.23–0.90); P = 0.02), operating time (weighted mean difference (WMD) 95% CI, −19.53 (−29.35 to −9.71); P < 0.0001), and hospital stay (WMD 95% CI, −4.16 (−7.07 to −1.24); P = 0.005) except peri-operative mortality (OR 95% CI, 0.83 (0.11–6.37); P = 0.86), residual stones (OR 95% CI, 0.70 (0.22–2.25); P = 0.55), and abdominal collections (OR 95% CI, 1.93 (0.34–10.76); P = 0.46). And the result of wound infection (OR 95% CI, 0.38 (0.14–1.02); P = 0.05) tended to favor the primary closure group.
Conclusion
The primary closure might be as effective as T-tube drainage after choledochotomy in the prevention of the development of post-operative complications.