Orthotopic liver transplantation: T-tube or not T-tube? Systematic review and meta-analysis of results.
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.
Sotiropoulos
Georgios C
GC
Department of General and Abdominal Surgery, Johannes Gutenberg University Hospital, Mainz, Germany. sotiropoulos@ach.klinik.uni-mainz.de
Sgourakis
George
G
Radtke
Arnold
A
Molmenti
Ernesto P
EP
Goumas
Konstantinos
K
Mylona
Sofia
S
Fouzas
Ioannis
I
Karaliotas
Constantine
C
Lang
Hauke
H
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