Primary closure versus T-tube drainage after laparoscopic common bile duct stone exploration

  • Review
  • Intervention

Authors

  • Kurinchi Selvan Gurusamy,

    Corresponding author
    1. Royal Free Hospital and University College School of Medicine, University Department of Surgery, London, UK
    • Kurinchi Selvan Gurusamy, University Department of Surgery, Royal Free Hospital and University College School of Medicine, 9th Floor, Royal Free Hospital, Pond Street, London, NW3 2QG, UK. kurinchi2k@hotmail.com.

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  • Kumarakrishnan Samraj

    1. John Radcliffe Hospital, Department of General Surgery, Oxford, UK
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Abstract

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.

Objectives

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

Search 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.

Selection criteria

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.

Data collection and analysis

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.

Main 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.

Authors' 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.

摘要

背景

比較腹腔鏡總膽管結石取石術之後以初步縫合或以對照TTUBE引流術之比較

人們對腹腔鏡膽總管探查之後實施TTUBE引流術的做法一直存有爭議。我們不能找到針對腹腔鏡膽總管探查之後實施TTUBE引流術的利弊而實施的統合分析或系統性文獻回顧

目標

評估在腹腔鏡總膽管結石取石術之後常規實施初步縫合或以TTUBE引流術之比較。

搜尋策略

我們搜尋截至2006年1月前的The Cochrane HepatoBiliary Group Controlled Trials Register ,Cochrane Library的Cochrane Central Register of Controlled Trials (CENTRAL) 、MEDLINE、EMBASE和Science Citation Index Expanded。

選擇標準

我們收錄所有在腹腔鏡總膽管探查術之後比較初步縫合(含有或不含有膽道支架)或TTUBE引流術的隨機臨床試驗。

資料收集與分析

我們從一個找到已確定的試驗中收集有關試驗特性,方法學品質、死亡率、發病率、手術時間和住院日數等資料。我們使用RevMan分析軟體以固定效果模式分析資料。對於每個結果(outcome),我們根據治療意向,計算odds ratio,(OR)和加權平均差(weighted mean difference,WMD)及95%信賴區間。

主要結論

共包括1個試驗,隨機分配 55 位病人: 27 人被分配到初步縫合組,28人被分配到TTUBE組。本次試驗的方法學品質並不恰當。各個小組沒有提到死亡率,除了住院日數 (WMD −2.8 天, 95% CI −1.93 3.67)以外,初步縫合組的住院日較短。兩個小組對任何結果都沒有統計上顯著差異。

作者結論

我們沒有足夠的證據建議腹腔鏡總膽管結石探查術之後TTUBE引流術優於初步縫合,反之亦然。 需要實施進一步的隨機試驗來評估腹腔鏡總膽管探查術之後實施TTUBE引流術對照初步縫合的利弊。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

初步縫合看似和腹腔鏡總膽管探查術之後實施的TTUBE引流術同樣有效。觀察研究對於腹腔鏡總膽管探查取石術之後實施TTUBE引流術卻得出互相矛盾的結果。 只有一個隨機試驗在腹腔鏡總膽管取石術之後比較初步縫合(27 位病人) 和TTUBE引流術 (28 位病人) ,但是研究方法品質不適當。TTUBE引流術組和無膽道支架的初步縫合組,除住院日數以外,在任何結果上沒有顯示有統計上顯著差異。仍需要實施進一步的隨機試驗來評估腹腔鏡總膽管探查術之後實施TTUBE引流術對照初步縫合的利弊。

Plain language summary

Primary closure seems to be equally effective as T-tube drainage after laparoscopic common bile duct exploration

Observational studies reach conflicting results on the use of T-tube drainage after laparoscopic common bile duct exploration of stones. Only one randomised trial of inadequate methodological quality has compared primary closure (27 patients) with T-tube drainage (28 patients) following laparoscopic exploration of the common bile duct for stones. There was no statistically significant difference in any of the outcomes between the T-tube group and the primary closure without biliary stent group except in the hospital stay. More randomised trials are necessary to assess the benefits and harms of T-tube drainage versus primary closure after laparoscopic common bile duct exploration.