Primary Closure Versus T-Tube Drainage on Common Bile Duct Exploration for Choledocholithiasis: An Updated Systematic Review and Meta-Analysis.

Introduction

Laparoscopic common bile duct exploration (LCBDE) is a critical procedure for managing choledocholithiasis, with primary closure (PC) and T-tube drainage (TTD) as common methods for common bile duct closure. However, the substantial number of new studies comparing PC and TTD underscores the need for an updated meta-analysis. Therefore, this study aims to compare surgery-related outcomes in PC and TTD for biliary duct closure following LCBDE.

Methods

We searched PubMed, Embase, and Cochrane Library databases on June 20, 2024. Mean differences (MDs) and risk ratios with 95% confidence intervals (CIs) were pooled for continuous and binary outcomes, respectively. Heterogeneity was assessed with I2 statistics. Statistical analysis was performed using Software R, version 4.3.3.

Results

A total of 31 studies comprising 4432 patients were included. A total of 2301 (51.9%) were submitted to PC and 2131 (48.1%) were submitted to TTD. The mean age of patients ranged from 39 to 69.8 years and 44.3% were male. Compared with TTD, PC significantly reduced retained stones (odds ratio [OR] 0.57; 95% CI 0.35-0.93; P = .02; I2 = 0%), biliary peritonitis (OR 0.22; 95% CI 0.08-0.60; P < .01; I2 = 0%), operative time (MD -21.07 minutes; 95% CI -27.68-14.46; P <. 01; I2 = 97%) and postoperative hospital stay (MD -2.20 days; 95% CI -2.80-1.60; P <. 01; I2 = 96%). However, there were no significant differences between the groups in recurrent stones (OR 0.57; 95% CI 0.32-1.02; P = .06; I2 = 0%), bile leakage (OR 0.89; 95% CI 0.65-1.23; P = .49; I2 = 0%), bile duct stricture (OR 2.08; 95% CI 0.36-12.11; P = .42; I2 = 0%), pneumonia (OR 1.38; 95% CI 0.66-2.88; P = .39; I2 = 0%), and pancreatitis (OR 0.64; 95% CI 0.29-1.38; P = .25; I2 = 0%).

Conclusion

In this meta-analysis, PC was associated with decreased retained stones, biliary peritonitis, operative time, and postoperative hospital stay. However, no significant differences were observed for the other outcomes. These findings underscore PC as a safe and reliable method for bile duct closure following LCBDE.