title: Orthotopic liver transplantation: T-tube or not T-tube? Systematic review and meta-analysis of results.
abstract: BACKGROUND
  The purpose of this study was to compare outcomes after duct-to-duct anastomoses with or without biliary T-tube in orthotopic liver transplantation.
  
  
  METHODS
  We pooled the outcomes of 1027 patients undergoing choledocho-choledochostomy with or without T-tube in 9 of 46 screened trials by means of fixed or random effects models.
  
  
  RESULTS
  The "without T-tube" and "with T-tube" groups had equivalent outcomes for: anastomotic bile leaks or fistulas, choledocho-jejunostomy revisions, dilatation and stenting, hepatic artery thromboses, retransplantation, and mortality due to biliary complications. The "without T-tube" group had better outcomes when considering "fewer episodes of cholangitis," "fewer episodes of peritonitis," and showed a favorable trend for "overall biliary complications." Although the "with T-tube" group showed superior result for "anastomotic and nonanastomotic strictures," the incidence of interventions was not diminished.
  
  
  CONCLUSIONS
  Our systematic review and meta analysis favor the abandonment of T-tubes in orthotopic liver transplantation.
authors.affiliation: Department of General and Abdominal Surgery, Johannes Gutenberg University Hospital, Mainz, Germany. sotiropoulos@ach.klinik.uni-mainz.de
authors.forename: Georgios C
authors.initials: GC
authors.lastname: Sotiropoulos
authors.forename: George
authors.initials: G
authors.lastname: Sgourakis
authors.forename: Arnold
authors.initials: A
authors.lastname: Radtke
authors.forename: Ernesto P
authors.initials: EP
authors.lastname: Molmenti
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Goumas
authors.forename: Sofia
authors.initials: S
authors.lastname: Mylona
authors.forename: Ioannis
authors.initials: I
authors.lastname: Fouzas
authors.forename: Constantine
authors.initials: C
authors.lastname: Karaliotas
authors.forename: Hauke
authors.initials: H
authors.lastname: Lang
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D002768:Choledochostomy / Q000009:adverse effects / Q000379:methods / Q000592:standards; D018450:Disease Progression; D005260:Female; D005705:Gallbladder Diseases / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality / Q000502:physiology / Q000592:standards; D008297:Male; D016017:Odds Ratio; D010538:Peritonitis / Q000453:epidemiology / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology / Q000601:surgery; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies