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T-tube drainage versus primary closure after open common bile duct exploration

  1. Kurinchi Selvan Gurusamy*,
  2. Rahul Koti,
  3. Brian R Davidson

Editorial Group: Cochrane Hepato-Biliary Group

Published Online: 21 JUN 2013

Assessed as up-to-date: 10 APR 2013

DOI: 10.1002/14651858.CD005640.pub3


How to Cite

Gurusamy KS, Koti R, Davidson BR. T-tube drainage versus primary closure after open common bile duct exploration. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD005640. DOI: 10.1002/14651858.CD005640.pub3.

Author Information

  1. Royal Free Campus, UCL Medical School, Department of Surgery, London, UK

*Kurinchi Selvan Gurusamy, Department of Surgery, Royal Free Campus, UCL Medical School, Royal Free Hospital,, Rowland Hill Street, London, NW3 2PF, UK. kurinchi2k@hotmail.com.

Publication History

  1. Publication Status: New search for studies and content updated (conclusions changed)
  2. Published Online: 21 JUN 2013

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[Figure 1]
Figure 1. Study flow diagram.
[Figure 2]
Figure 2. Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
[Figure 3]
Figure 3. Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
[Figure 4]
Figure 4. Trial sequential analysis of mortality The diversity-adjusted required information size (DARIS) was calculated to 140,645 patients, based on the proportion of patients in the control group with the outcome of 0.5%, a relative risk reduction of 20%, an alpha of 5%, a beta of 20%, and a diversity of 0%. After accruing 359 patients in the six trials, only 0.26% of the DARIS has been reached. Accordingly, the trial sequential analysis does not show the required information size and the trial sequential monitoring boundaries. As shown, the conventional boundaries have also not been crossed.
[Figure 5]
Figure 5. Trial sequential analysis of duration of hospital stayThe diversity-adjusted required information size (DARIS) was 20,538 patients, based on a minimal relevant difference (MIRD) of one day, a variance (VAR) of 25.59, an alpha (a) of 5%, a beta (b) of 20%, and a diversity (D2) of 96.09%. After accruing 333 patients in the five trials, only 1.62% of the DARIS has been reached. Accordingly, the trial sequential analysis does not show the required information size and the trial sequential monitoring boundaries. As shown, the conventional boundary has been crossed for longer stay favouring primary closure.
[Analysis 1.1]
Analysis 1.1. Comparison 1 T-tube drainage versus primary closure, Outcome 1 Peri-operative mortality.
[Analysis 1.2]
Analysis 1.2. Comparison 1 T-tube drainage versus primary closure, Outcome 2 Serious morbidity.
[Analysis 1.3]
Analysis 1.3. Comparison 1 T-tube drainage versus primary closure, Outcome 3 Morbidity (severity unknown).
[Analysis 1.4]
Analysis 1.4. Comparison 1 T-tube drainage versus primary closure, Outcome 4 Serious morbidity.
[Analysis 1.5]
Analysis 1.5. Comparison 1 T-tube drainage versus primary closure, Outcome 5 Operating time.
[Analysis 1.6]
Analysis 1.6. Comparison 1 T-tube drainage versus primary closure, Outcome 6 Hospital stay.