Primary closure versus T-tube drainage after common bile duct exploration for choledocholithiasis.
OBJECTIVE
The aim of this study was to evaluate the benefits and harms of primary closure versus T-tube drainage after common bile duct (CBD) exploration for choledocholithiasis.


METHODS
A literature search of MEDLINE (PubMed), EMBASE, and the Cochrane Library was done to identify randomized controlled trials assessing the benefits and harms of primary closure versus T-tube drainage after CBD exploration from Jan. 1990 to Apr. 2010. A meta-analysis was set up to distinguish overall difference between the primary closure and the T-tube drainage group.


RESULTS
There were statistically significant differences between groups: biliary complications (odds ratio (OR) 95% confidence interval (CI), 0.42 (0.19-0.92); P = 0.03), main complications (OR 95% CI, 0.46 (0.23-0.90); P = 0.02), operating time (weighted mean difference (WMD) 95% CI, -19.53 (-29.35 to -9.71); P < 0.0001), and hospital stay (WMD 95% CI, -4.16 (-7.07 to -1.24); P = 0.005) except peri-operative mortality (OR 95% CI, 0.83 (0.11-6.37); P = 0.86), residual stones (OR 95% CI, 0.70 (0.22-2.25); P = 0.55), and abdominal collections (OR 95% CI, 1.93 (0.34-10.76); P = 0.46). And the result of wound infection (OR 95% CI, 0.38 (0.14-1.02); P = 0.05) tended to favor the primary closure group.


CONCLUSIONS
The primary closure might be as effective as T-tube drainage after choledochotomy in the prevention of the development of post-operative complications.
Zhu
Qian D
QD
Department of General Surgery, The First Affiliated Hospital, Wenzhou Medical College, Wenzhou, 325003, Zhejiang, China. sinozqd@163.com
Tao
Chong L
CL
Zhou
Meng T
MT
Yu
Zheng P
ZP
Shi
Hong Q
HQ
Zhang
Qi Y
QY
D058107:Abdominal Wound Closure Techniques; D002768:Choledochostomy / Q000379:methods*; D004322:Drainage / Q000379:methods*; D042882:Gallstones / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis; D013536:Suture Techniques