Journal of Surgery Concepts & Practice >

2025 , Vol. 30 >Issue 2: 151 - 158

DOI: https://doi.org/10.16139/j.1007-9610.2025.02.10

Original article

Meta-analysis of comparative clinical outcomes between primary closure and T-tube drainage following laparoscopic common bile duct exploration and extraction combined with cholecystectomy

  • WANG Ping ,
  • BAO Hui ,
  • SONG Zhenshun
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  • 1a. Department of Hepato-Biliary-Pancreatic Surgery, b. Department of Cardiovascular Medicine, Taizhou Fourth People's Hospital, Jiangsu Taizhou225300,China
    2. Department of Hepatobiliary and Pancreatic Surgery, Shanghai Fourth People's Hospital affiliated to Tongji University, Shanghai 200434, China

Received date: 2024-05-15

  Online published: 2025-07-07

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Abstract

Objective To systematically evaluate the comparative efficacy of primary closure versus T-tube drainage following laparoscopic common bile duct exploration (LCBDE) and extraction combined with cholecystectomy in the management of choledocholithiasis with concomitant cholecystolithiasis.Methods A comprehensive search of databases including PubMed, CNKI, Wanfang, and VIP was conducted from January 1, 2012, to December 31, 2021. Eligible studies were screened based on predefined inclusion/exclusion criteria, and meta-analysis was performed using Review Manager 5.4 software.Results Ten studies involving 1 589 patients (783 primary closure vs. 806 T-tube drainage) were included. Meta-analysis demonstrated that primary closure significantly reduced operation time [MD = -15.59, 95% CI: (-23.74, -7.45), P = 0.000 2], intraoperative blood loss [MD = -6.49, 95% CI: (-12.74, -0.24), P = 0.04], postoperative gastrointestinal recovery time [MD = -0.39, 95% CI: (-0.60, -0.19), P= 0.000 2], postoperative hospital stay [MD = -1.41, 95% CI: (-2.19, -0.62), P = 0.000 4], and hospitalization costs [SMD = -0.66, 95% CI: (-1.21, -0.12), P = 0.02].Conclusions Both closure methods are safe and effective for choledocholithiasis with cholecystolithiasis. However, primary closure offers advantages including shorter operative duration, reduced blood loss, decreased hospital stay, and lower costs, warranting broader clinical adoption.

Key words： Common bile duct stone; Laparoscopic common bile duct exploration(LCBDE) and extraction; Primary closure（PC）; T-tube drainage(TD)

Cite this article

WANG Ping , BAO Hui , SONG Zhenshun . Meta-analysis of comparative clinical outcomes between primary closure and T-tube drainage following laparoscopic common bile duct exploration and extraction combined with cholecystectomy[J]. Journal of Surgery Concepts & Practice, 2025 , 30(2) : 151 -158 . DOI: 10.16139/j.1007-9610.2025.02.10

References

[1] 吴在德, 吴孟超. 黄家驷外科学[M]. 北京: 人民卫生出版社, 2008.
  WU Z D, WU M C. Huang Jiasi’s Textbook of Surgery[M]. Beijing: People’s Medical Publishing House, 2008.
[2] 马大喜, 李可为, 程明荣, 等. LC+LCBDE胆总管一期缝合与T管引流治疗胆囊胆总管结石的随机对照研究[J]. 海南医学, 2018, 29(7):930-934.
  MA D X, LI K W, CHENG M R, et al. A randomized controlled trial of primary suture versus T-tube drainage in laparoscopic cholecystectomy and common bile duct exploration for cholecystocholedocholithiasis[J]. Hainan Med J, 2018, 29(7):930-934.
[3] DONG Z T, WU G Z, LUO K L, et al. Primary closure after laparoscopic common bile duct exploration versus T-tube[J]. J Surg Res, 2014, 189(2):249-254.
[4] XIAO L K, XIANG J F, WU K, et al. The reasonable drainage option after laparoscopic common bile duct exploration for the treatment of choledocholithiasis[J]. Clin Res Hepatol Gastroenterol, 2018, 42(6):564-569.
[5] ZHANG W J, XU G F, HUANG Q, et al. Treatment of gallbladder stone with common bile duct stones in the laparoscopic era[J]. BMC surgery,2015, 15:7
[6] 黄博, 陈一帆, 翟敏, 等. 胆总管结石术后一期缝合与T管引流的疗效对比及复发因素分析[J]. 中国医刊, 2021, 56(9):980-984.
  HUANG B, CHEN Y F, ZHAI M, et al. Comparison of curative effect of primary suture and T-tube drainage after choledocholithiasis and analysis of recurrence factors[J]. Chin Med J, 2021, 56(9):980-984.
[7] 沈彪, 宋振顺. 腹腔镜胆总管探查联合免T管一期缝合术治疗胆总管结石的疗效研究[J]. 湖南师范大学学报(医学版), 2018, 15(3):69-71.
  SHEN B, SONG Z S. Curative effect of laparoscopic choledochal exploration combined with one-stage T-tube-free suture in the treatment of choledocholithiasis[J]. J Hunan Norm Univ(Med Ed), 2018, 15(3):69-71.
[8] 李志钰, 尹飞飞, 孙世波. 腹腔镜胆总管探查取石一期缝合与T管引流的临床对比研究[J]. 腹腔镜外科杂志, 2015, 20(3):215-218.
  LI Z Y, YIN F F, SUN S B. A comparative study of laparoscopic primary suture and T-tube drainage for common bile duct exploration[J]. J Laparosc Surg, 2015, 20(3):215-218.
[9] 梁阔, 刘东斌, 刘家峰, 等. 老年患者腹腔镜胆总管探查一期缝合与T管引流的临床疗效分析[J]. 腹腔镜外科杂志, 2017, 22(10):774-777.
  LIANG K, LIU D B, LIU J F, et al. Clinical efficacy analysis of primary suture and T-tube drainage in elderly patients with laparoscopic common bile duct exploration[J]. J Laparosc Surg, 2017, 22(10):774-777.
[10] 练远书, 黄高, 陆开艺, 等. 两种手术方法对胆总管直径≥1.0 cm结石患者的疗效分析[J]. 中华普外科手术学杂志(电子版), 2020, 14(5):530-533.
  LIAN Y S, HUANG G, LU K Y, et al. Efficacy analysis of two surgical methods for patients with choledocholithiasis ≥1.0 cm in diameter[J]. Chin J Gen Surg(Electron Ed), 2020, 14(5):530-533.
[11] 李文心, 何忠野, 王开宇, 等. 三种不同微创方式治疗胆总管结石不伴有胆囊结石的疗效观察[J]. 河北医学, 2019, 25(10):1718-1721.
  Li W X, He Z Y, Wang K Y, et al. Observation on the efficacy of three different minimally invasive methods in the treatment of common bile duct stones without gallbladder stones[J]. Hebei Med, 2019, 25(10):1718-1721.
[12] PETELIN J B. Laparoscopic approach to common duct pathology[J]. Am J Surg, 1993, 165(4):487-491.
[13] ZHOU H, WANG S, FAN F, et al. Primary closure with knotless barbed suture versus traditional T-tube drainage after laparoscopic common bile duct exploration: a single-center medium-term experience[J]. J Int Med Res, 2020, 48(1):300060519878087.
[14] ZHEN W, XU ZHEN W, NAN TAO F, et al. Primary closure versus T-tube drainage following laparoscopic common bile duct exploration in patients with previous bilia-ry surgery[J]. Am Surg, 2021, 87(1):50-55.
[15] STOKER M E, LEVEILLEE R J, MCCANN J C JR, et al. Laparoscopic common bile duct exploration[J]. J Laparoendosc Surg, 1991, 1(5):287-293.
[16] PANG L, WU S, KONG J. Laparoscopic transcystic common bile duct exploration (LTCBDE): a safer method to treat common bile duct stones than laparoscopic choledochotomy[J]. Rev Esp Enferm Dig, 2020, 112(6):507-508.
[17] GUAN H, JIANG G, MAO X. Primary duct closure combined with transcystic drainage versus T‐tube drainage after laparoscopic choledochotomy[J]. ANZ J Surg, 2019, 89(7-8):885-888.
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