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Yuan B, Zhang X, Kong C, Zhang C, Li H. Application of laparoscopic backtracking full-thickness continuous everting suture for non-AOSC choledocholithiasis. BMC Surg 2023; 23:315. [PMID: 37848861 PMCID: PMC10583331 DOI: 10.1186/s12893-023-02222-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/06/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Based on the current trend of increasing incidence of choledocholithiasis, it is of great significance to explore the closure method of the common bile duct during laparoscopic choledocholithotomy. METHODS Backtracking full-thickness continuous everting suture was selected for primary closure of the common bile duct suture, while traditional T-tube drainage was selected for the control group. Propensity score matching (PSM) was used to reduce baseline differences between the two groups. RESULT The intraoperative blood loss, operation time, postoperative recovery speed, postoperative bleeding, postoperative pancreatitis, recurrence rate of bile duct stones, and hospitalization time in the primary closure group were all less than those in the T-tube drainage group. CONCLUSION Under certain conditions, backtracking full-thickness continuous everting suture could benefit patients with choledocholithiasis compared with traditional T-tube drainage.
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Affiliation(s)
- Bo Yuan
- Center of Hepatobiliary Pancreatic Disease, XuZhou Central Hospital, Xuzhou, Jiangsu PR China
| | - Xuanfeng Zhang
- Center of Hepatobiliary Pancreatic Disease, XuZhou Central Hospital, Xuzhou, Jiangsu PR China
| | - Chenchen Kong
- Center of Hepatobiliary Pancreatic Disease, XuZhou Central Hospital, Xuzhou, Jiangsu PR China
| | - Cancan Zhang
- Department of Gastroenterology and Endocrinology, XuZhou Central Hospital, Xuzhou, Jiangsu PR China
| | - Huansong Li
- Center of Hepatobiliary Pancreatic Disease, XuZhou Central Hospital, Xuzhou, Jiangsu PR China
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Fan L, Wang Y, Wu M, Wu T, Deng L, Wang Y, Liu L, An T. Laparoscopic common bile duct exploration with primary closure could be safely performed among elderly patients with choledocholithiasis. BMC Geriatr 2023; 23:486. [PMID: 37568121 PMCID: PMC10416467 DOI: 10.1186/s12877-023-04149-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 07/03/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND For patients with choledocholithiasis, laparoscopic common bile duct exploration (LCBDE) is preferred over open surgery. Whether primary closure of the common bile duct (CBD) should be performed upon completion of choledochotomy remains unclear, and the corresponding indications for primary closure of the common bile duct have yet to be fully identified. This study was performed to evaluate the safety and feasibility of primary closure of CBD among elderly patients (≥ 70 years) after LCBDE. METHODS Patients with choledocholithiasis who had undergone LCBDE with primary closure of the CBD between July 2014 and December 2020 were retrospectively reviewed. Included patients were assigned into two groups (Group A: ≥70 years and Group B: <70 years) according to age. Group A was compared with Group B in terms of preoperative characteristics, intraoperative results and postoperative outcomes. RESULTS The mean operative time for Group A was 176.59 min (± 68.950), while the mean operative time for Group B was 167.64 min (± 69.635) (P = 0.324). The mean hospital stay after surgery for Group A was 8.43 days (± 4.440), while that for Group B was 8.30 days (± 5.203) (P = 0.849). Three patients in Group A experienced bile leakage, while bile leakage occurred in 10 patients in Group B (3.8% vs. 4.5%, P = 0.781). Group A was not significantly different from Group B in terms of postoperative complications and 30-day mortality except pneumonia (P = 0.016), acute cardiovascular event (P = 0.005) and ICU observation (P = 0.037). After a median follow-up time of 60 months, 2 patients in Group A and 2 patients in Group B experienced stone recurrence (2.5% vs. 0.9%, P = 0.612). One patient in Group A experienced stenosis of the CBD, while stenosis of the CBD occurred in 5 patients in Group B (1.3% vs. 2.2%, P = 0.937). CONCLUSIONS Primary closure of CBD upon completion of LCBDE could be safely performed among patients ≥ 70 years.
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Affiliation(s)
- Lili Fan
- Department of Geriatric Medicine, Shenzhen Traditional Chinese Medicine Hospital, Fuhua Road 1, Futian District, Shenzhen, 518033, Guangdong, China
| | - Yan Wang
- Department of Radiology, Shenzhen People's Hospital, Dongmen Road 1017, Luohu District, Shenzhen, 518020, Guangdong, China
| | - Meilong Wu
- Department of Hepatobiliary and Pancreatic Surgery, Shenzhen People's Hospital, Dongmen Road 1017, Luohu District, Shenzhen, 518020, Guangdong, China
| | - Tianchong Wu
- Department of Hepatobiliary and Pancreatic Surgery, Shenzhen People's Hospital, Dongmen Road 1017, Luohu District, Shenzhen, 518020, Guangdong, China
| | - Lingna Deng
- Department of Pathology, Qingyuan People's Hospital, Yinquan Road B24, Qingcheng District, Qingyuan, 511518, Guangdong, China
| | - Yawei Wang
- The First Department of Surgery, Shenzhen Traditional Chinese Medicine Hospital, Fuhua Road 1, Futian District, Shenzhen, 518033, Guangdong, China
| | - Linsen Liu
- Department of Hepatobiliary and Pancreatic Surgery, Shenzhen People's Hospital, Dongmen Road 1017, Luohu District, Shenzhen, 518020, Guangdong, China.
| | - Tailai An
- Department of Hepatobiliary and Pancreatic Surgery, Shenzhen People's Hospital, Dongmen Road 1017, Luohu District, Shenzhen, 518020, Guangdong, China.
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Podda M, Ielpo B. Invited Commentary to "Safety and Feasibility of Primary Closure Following Laparoscopic Common Bile Duct Exploration for Treatment of Choledocholithiasis" by Lunjian Xiang et al. World J Surg 2023; 47:1031-1032. [PMID: 36703000 DOI: 10.1007/s00268-023-06917-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2023] [Indexed: 01/27/2023]
Affiliation(s)
- Mauro Podda
- Emergency Surgery Unit, Department of Surgical Science, Cagliari University Hospital, University of Cagliari, Policlinico Universitario "D. Casula", Azienda Ospedaliero-Universitaria di Cagliari, SS 554, Km 4,500, 09042, Cagliari, Monserrato, Italy.
| | - Benedetto Ielpo
- Hepatobiliary and Pancreatic Surgery Unit, Hospital del Mar. Universitat Pompeu Fabra, Barcelona, Spain
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Yang S, Wu S, Dai W, Pang L, Xie Y, Ren T, Zhang X, Bi S, Zheng Y, Wang J, Sun Y, Zheng Z, Kong J. Laparoscopic surgery for gallstones or common bile duct stones: A stably safe and feasible surgical strategy for patients with a history of upper abdominal surgery. Front Surg 2022; 9:991684. [PMID: 36248372 PMCID: PMC9562259 DOI: 10.3389/fsurg.2022.991684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/08/2022] [Indexed: 12/03/2022] Open
Abstract
Backgrounds/Aims A history of upper abdominal surgery has been identified as a relative contraindication for laparoscopy. This study aimed to compare the clinical efficacy and safety of laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) in patients with and without previous upper abdominal surgery. Methods In total, 131 patients with previous upper abdominal surgery and 64 without upper abdominal surgery underwent LC or LCBDE between September 2017 and September 2021 at the Shengjing Hospital of China Medical University. Patients with previous upper abdominal surgery were divided into four groups: group A included patients with previous right upper abdominal surgery who underwent LC (n = 17), group B included patients with previous other upper abdominal surgery who underwent LC (n = 66), group C included patients with previous right upper abdominal surgery who underwent LCBDE (n = 30), and group D included patients with previous other upper abdominal surgery who underwent LCBDE (n = 18). Patient demographics and perioperative outcomes were retrospectively analyzed. Results The preoperative liver function indexes showed no significant difference between the observation and control groups. For patients who underwent LC, groups A and B had more abdominal adhesions than the control group. One case was converted to open surgery in each of groups A and B. There was no statistical difference in operation time, estimated blood loss, postoperative hospital stay, and drainage volume. For patients who underwent LCBDE, groups C and D had more estimated blood loss than the control group (group C, 41.33 ± 50.84 vs. 18.97 ± 13.12 ml, p = 0.026; group D, 66.11 ± 87.46 vs. 18.97 ± 13.12 ml, p = 0.036). Compared with the control group, group C exhibited longer operative time (173.87 ± 60.91 vs. 138.38 ± 57.38 min, p = 0.025), higher drainage volume (296.83 ± 282.97 vs. 150.83 ± 127.04 ml, p = 0.015), and longer postoperative hospital stay (7.97 ± 3.68 vs. 6.17 ± 1.63 days, p = 0.021). There was no mortality in all groups. Conclusions LC or LCBDE is a safe and feasible procedure for experienced laparoscopic surgeons to perform on patients with previous upper abdominal surgery.
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Affiliation(s)
- Shaojie Yang
- Biliary Surgery (2nd General) Unit, Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shuodong Wu
- Biliary Surgery (2nd General) Unit, Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Wanlin Dai
- Innovation Institute of China Medical University, Shenyang, China
| | - Liwei Pang
- Breast Surgery Unit, Department of General Surgery, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Yaofeng Xie
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Tengqi Ren
- Department of Urinary Surgery, Taizhou Enze Medical Center (Group) Enze Hospital, Taizhou, China
| | - Xiaolin Zhang
- Biliary Surgery (2nd General) Unit, Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shiyuan Bi
- Biliary Surgery (2nd General) Unit, Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yuting Zheng
- Biliary Surgery (2nd General) Unit, Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jingnan Wang
- Biliary Surgery (2nd General) Unit, Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yang Sun
- Biliary Surgery (2nd General) Unit, Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhuyuan Zheng
- Biliary Surgery (2nd General) Unit, Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jing Kong
- Biliary Surgery (2nd General) Unit, Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
- Correspondence: Jing Kong
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Omar MA, Redwan AA, Alansary MN. Comparative study of three common bile duct closure techniques after choledocholithotomy: safety and efficacy. Langenbecks Arch Surg 2022; 407:1805-1815. [PMID: 35786738 PMCID: PMC9399200 DOI: 10.1007/s00423-022-02597-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 06/20/2022] [Indexed: 10/31/2022]
Abstract
PURPOSE T-tube drainage, primary closure, and biliary stenting are the common bile duct closure methods. There is great debate on the optimal duct closure technique after common bile duct exploration. This study aimed to assess the safety and efficacy of the three commonest common bile duct closure methods after common bile duct exploration for common bile duct stone for future generalization. METHODS In this analysis, 211 patients with common bile duct stone underwent common bile duct exploration from January 2016 to December 2020. The patients were divided according to common bile duct closure techniques into three groups, including the T-tube drainage group (63 patients), primary duct closure group (61 patients), and antegrade biliary stenting group (87 patients). RESULTS The incidence of overall biliary complications and bile leak were statistically significantly lower in the biliary stenting group than in the other two groups. Also, hospital stays, drain carried time, return to normal activity, re-intervention, and re-admission rates were statistically significantly lower in the biliary stenting group than in the other two groups. There were no statistically significant differences regarding operative and choledochotomy time, retained and recurrent stone, stricture, biliary peritonitis, cholangitis, and the cost among the three groups. CONCLUSIONS We state that the biliary stenting procedure should be the preferred first option for common bile duct closure after common bile duct exploration when compared with T-tube drainage and primary duct closure. TRIAL REGISTRATION ClinicalTrials.gov PRS (Approval No. NCT04264299).
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Affiliation(s)
- Mohammed Ahmed Omar
- General Surgery Department, Faculty of Medicine, South Valley University, Qena, Egypt
| | - Alaa Ahmed Redwan
- General Surgery Department, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Marwa Nasrelden Alansary
- Anesthesia and Intensive Care Department, Qena Faculty of Medicine, South Valley University, Qena, Egypt
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Wang Y, Huang Y, Shi C, Wang L, Liu S, Zhang J, Wang W. Efficacy and safety of laparoscopic common bile duct exploration via choledochotomy with primary closure for the management of acute cholangitis caused by common bile duct stones. Surg Endosc 2022; 36:4869-4877. [PMID: 34724579 PMCID: PMC9160116 DOI: 10.1007/s00464-021-08838-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 10/21/2021] [Indexed: 12/07/2022]
Abstract
BACKGROUND T-tube drainage after laparoscopic common bile duct exploration (LCBDE) has been demonstrated to be safe and effective for patients with acute cholangitis caused by common bile duct stones (CBDSs). The outcomes after LCBDE with primary closure in patients with CBDS-related acute cholangitis are unknown. The present study aimed to evaluate the efficacy and safety of LCBDE with primary closure for the management of acute cholangitis caused by CBDSs. METHODS Between June 2015 and June 2020, 368 consecutive patients with choledocholithiasis combined with cholecystolithiasis, who underwent laparoscopic cholecystectomy (LC) + LCBDE in our department, were retrospectively reviewed. A total of 193 patients with CBDS-related acute cholangitis underwent LC + LCBDE with primary closure of the CBD (PC group) and 62 patients underwent LC + LCBDE followed by T-tube placement (T-tube group). A total of 113 patients who did not have cholangitis were excluded. The clinical data were compared and analyzed. RESULTS There was no mortality in either group. No significant differences were noted in morbidity, bile leakage rate, retained CBD stones, or readmission rate within 30 days between the two groups. Compared with the T-tube group, the PC group avoided T-tube-related complications and had a shorter operative time (121.12 min vs. 143.37 min) and length of postoperative hospital stay (6.59 days vs. 8.81 days). Moreover, the hospital expenses in the PC group were significantly lower than those in the T-tube group ($4844.47 vs. $5717.22). No biliary stricture occurred during a median follow-up of 18 months in any patient. No significant difference between the two groups was observed in the rate of stone recurrence. CONCLUSIONS LCBDE with primary closure is a safe and effective treatment for cholangitis caused by CBDSs. LCBDE with primary closure is not inferior to T-tube drainage for the management of CBDS-related acute cholangitis in suitable patients.
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Affiliation(s)
- Yanjun Wang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Fujian Medical University, 34 Zhongshanbei Road, Quanzhou, 362000, China
| | - Youbao Huang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Fujian Medical University, 34 Zhongshanbei Road, Quanzhou, 362000, China
| | - Chunfeng Shi
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Fujian Medical University, 34 Zhongshanbei Road, Quanzhou, 362000, China
| | - Linpei Wang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Fujian Medical University, 34 Zhongshanbei Road, Quanzhou, 362000, China
| | - Shengwei Liu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Fujian Medical University, 34 Zhongshanbei Road, Quanzhou, 362000, China
| | - Jiawei Zhang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Fujian Medical University, 34 Zhongshanbei Road, Quanzhou, 362000, China
| | - Wei Wang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Fujian Medical University, 34 Zhongshanbei Road, Quanzhou, 362000, China.
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Jiang Y, Lu J, Li W, Zhang J, Li L. Primary closure after laparoscopic common bile duct exploration is safe and feasible for patients with non-severe acute cholangitis. Langenbecks Arch Surg 2022; 407:1553-1560. [PMID: 35562540 DOI: 10.1007/s00423-022-02547-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 05/08/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND The safety and feasibility of primary closure after laparoscopic common bile duct exploration (LCBDE) have been confirmed in elective settings. However, the suitability of primary closure after LCBDE in the treatment of patients with non-severe acute cholangitis in emergency settings remains unclear. The aim of the present study was to explore the safety and feasibility of LCBDE with primary closure in patients with non-severe acute cholangitis. METHODS Consecutive patients with choledocholithiasis combined with gallbladder stones treated by LCBDE with primary closure at our institution from January 2015 to April 2021 were retrospectively reviewed. These patients were divided into two groups: emergency group (patients with non-severe acute cholangitis) and elective group (patients without acute cholangitis). The demographic and perioperative data of the two groups were compared. RESULTS One hundred twenty-two patients received LCBDE combined with primary closure during this period, including 70 in the emergency group and 52 in the elective group. Baseline characteristics were balanced in both groups, except for higher levels of white blood cells (WBC), C-reactive protein (CRP), total bilirubin, alkaline phosphatase (ALP), and albumin in the emergency group. No postoperative mortality occurred in either group. Compared to the elective group, the emergency group had a longer operation time (P = 0.011), and more estimated blood loss (P < 0.001). No significant differences were found between the two groups in terms of conversion (2.9% vs. 0.0%, P = 0.507), use of baskets (84.2% vs. 78.8%, P = 0.481), use of electrohydraulic lithotripsy (EHL) (2.9% vs. 1.9%, P = 1.000), or postoperative hospital stay (P = 0.214). The incidence of postoperative complications was comparable between the two groups. During the follow-up period, none of the patients experienced biliary stricture, and 1 case of stone recurrence occurred in the elective group. CONCLUSIONS LCBDE with primary closure for choledocholithiasis patients with non-severe acute cholangitis has the equivalent efficacy and morbidity to elective surgery. Primary closure after LCBDE is a safe and feasible option for choledocholithiasis patients with non-severe acute cholangitis.
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Affiliation(s)
- You Jiang
- Department of General Surgery, Hefei Second People's Hospital, Anhui Medical University, Hefei, 230011, Anhui Province, People's Republic of China
| | - Jun Lu
- Department of General Surgery, Hefei Second People's Hospital, Anhui Medical University, Hefei, 230011, Anhui Province, People's Republic of China
| | - Wenbo Li
- Department of General Surgery, Hefei Second People's Hospital, Anhui Medical University, Hefei, 230011, Anhui Province, People's Republic of China
| | - Jun Zhang
- Department of General Surgery, Hefei Second People's Hospital, Anhui Medical University, Hefei, 230011, Anhui Province, People's Republic of China
| | - Liang Li
- Department of General Surgery, Hefei Second People's Hospital, Anhui Medical University, Hefei, 230011, Anhui Province, People's Republic of China.
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Jiang Y, Zhang J, Li W, Li L. Primary closure versus T-tube drainage after laparoscopic common bile duct exploration in patients with non-severe acute cholangitis. Updates Surg 2022; 74:899-906. [PMID: 34988916 DOI: 10.1007/s13304-021-01214-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/30/2021] [Indexed: 12/07/2022]
Abstract
Although the feasibility of T-tube drainage after emergency laparoscopic common bile duct exploration (LCBDE) has been reported, the safety and effectiveness of primary closure (PC) after LCBDE in patients with non-severe acute cholangitis (AC) remain uncertain. This study aimed to investigate the safety and feasibility of PC after LCBDE in patients with non-severe AC. Consecutive choledocholithiasis patients with non-severe AC who were treated with a laparoscopic approach at our institution between January 2014 and March 2021 were enrolled. These patients were divided into two groups (PC group and T-tube group) based on the way of closure of the common bile duct. The baseline characteristics and perioperative data between the two groups were compared. A total of 230 patients who underwent LCBDE met the inclusion criteria, and there were 94 patients in the PC group and 126 patients in the T-tube group. Baseline data were balanced between the two groups, except that there was less acute cholecystitis in the PC group than in the T-tube group (P = 0.027). Compared to the T-tube group, the PC group had a shorter operation time (P < 0.001), less estimated blood loss (P < 0.001), less use of electrohydraulic lithotripsy (EHL) (P = 0.001), shorter time of drainage removal (P < 0.001) and postoperative hospital stay (P < 0.001) and residual stones (P = 0.029). There was no significant difference between the two groups in terms of conversion (4.3 vs. 4.4%, P = 1.000), intraoperative transfusion (0.0 vs. 0.7%, P = 1.000), use of basket (71.2 vs. 69.9%, P = 0.816), postoperative bleeding (1.1 vs. 0.7%, P = 1.000), biliary leakage (4.3 vs. 3.7%, P = 1.000), incision infection (1.1 vs. 2.2%, P = 0.649), pneumonia (2.1 vs. 1.4%, P = 1.000), or cholangitis (1.1 vs. 2.9%, P = 0.651). No postoperative mortality occurred in either group. During the follow-up period, no biliary stricture occurred in the two groups, and two patients in the T-tube group were found to have stone recurrence. PC after LCBDE in choledocholithiasis patients with non-severe AC shows superior clinical outcomes to T-tube drainage in terms of the operation time, estimated blood loss, time of drainage removal, postoperative hospital stay, and residual stones. PC is a safe and feasible treatment for choledocholithiasis patients with non-severe AC after LCBDE.
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Affiliation(s)
- You Jiang
- Department of General Surgery, Hefei Second People's Hospital, Anhui Medical University, Hefei, 230011, Anhui, People's Republic of China
| | - Jun Zhang
- Department of General Surgery, Hefei Second People's Hospital, Anhui Medical University, Hefei, 230011, Anhui, People's Republic of China
| | - Wenbo Li
- Department of General Surgery, Hefei Second People's Hospital, Anhui Medical University, Hefei, 230011, Anhui, People's Republic of China
| | - Liang Li
- Department of General Surgery, Hefei Second People's Hospital, Anhui Medical University, Hefei, 230011, Anhui, People's Republic of China.
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Zhu T, Lin H, Sun J, Liu C, Zhang R. Primary duct closure versus T-tube drainage after laparoscopic common bile duct exploration: a meta-analysis. J Zhejiang Univ Sci B 2021; 22:985-1001. [PMID: 34904412 DOI: 10.1631/jzus.b2100523] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS: Laparoscopic common bile duct exploration (LCBDE) is considered a safe and effective method for the removal of bile duct stones. However, the choice of primary duct closure (PDC) or T-tube drainage (TTD) technique after LCBDE is still controversial. This study aimed to compare the safety and effectiveness of PDC and TTD after LCBDE. METHODS: Studies published before May 1, 2021 in PubMed, Web of Science, and Cochrane Library databases were searched to screen out randomized controlled trials (RCTs) and cohort studies to compare PDC with TTD. Meta-analyses of fixed effect and random effect models were performed using RevMan 5.3. RESULTS: A total of 1865 patients were enrolled in six RCTs and ten cohort studies. Regarding RCTs, the PDC group was significantly better than the TTD group in terms of operation time, total postoperative complications, postoperative hospital stay, and hospitalization expenses (all P<0.05). Based on cohort studies of the subgroup, the PDC group had shorter operation time, shorter postoperative hospital stay, less intraoperative blood loss, and limited total postoperative complications. Statistically, there were no significant differences in bile leakage, retained stones, stone recurrence, bile duct stricture, postoperative pancreatitis, other complications, or postoperative exhaust time between the TTD and PDC groups. CONCLUSIONS: Based on the available evidence, compared with TTD, PDC is safe and effective, and can be used as the first choice after transductal LCBDE in patients with choledocholithiasis.
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Affiliation(s)
- Taifeng Zhu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation and Department of Biliary-Pancreatic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Haoming Lin
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation and Department of Biliary-Pancreatic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Jian Sun
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation and Department of Biliary-Pancreatic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Chao Liu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation and Department of Biliary-Pancreatic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China. ,
| | - Rui Zhang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation and Department of Biliary-Pancreatic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.
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