Primary closure versus T-tube drainage after laparoscopic common bile duct stone exploration.
BACKGROUND
Use of T-tube drainage after laparoscopic common bile duct exploration is controversial. We were unable to identify any meta-analysis or systematic reviews of the benefits and harms of T-tube drainage after common bile duct exploration.


OBJECTIVE
To assess the benefits and harms of routine primary closure versus T-tube drainage following laparoscopic common bile duct stone exploration.


METHODS
We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until January 2006.


METHODS
We considered for inclusion all randomised clinical trials comparing primary closure (with or without a biliary stent) versus T-tube drainage after laparoscopic common bile duct exploration.


METHODS
We collected the data on the characteristics, methodological quality, mortality, morbidity, operating time, and hospital stay from the one identified trial. We analysed the data using the fixed-effect model using RevMan Analysis. For each outcome we calculated the odds ratio (OR) and weighted mean difference (WMD) with 95% confidence intervals based on intention-to-treat analysis.


RESULTS
We included one trial with 55 patients randomised: 27 to the primary closure and 28 to the T-tube group. This trial was of inadequate methodological quality. There was no mortality in either group. There was no statistically significant difference between the two groups for any of the outcomes except for the hospital stay (WMD -2.8 days, 95% CI -1.93 to -3.67), which was lower in the primary closure group.


CONCLUSIONS
We have insufficient evidence to recommend T-tube drainage over primary closure after laparoscopic common bile duct stone exploration or vice versa. Further randomised trials are necessary to assess the benefits and harms of T-tube drainage compared with primary closure after laparoscopic common bile duct exploration.
Gurusamy
K S
KS
Royal Free Hospital, Surgery, 291 Greenhaven Drive, Thamesmead, London, UK, SE28 8FY. kurinchi2k@hotmail.com
Samraj
K
K
D042883:Choledocholithiasis / Q000601:surgery*; D003135:Common Bile Duct / Q000601:surgery*; D004322:Drainage / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*