Primary Closure Versus T-Tube Drainage on Common Bile Duct Exploration for Choledocholithiasis: An Updated Systematic Review and Meta-Analysis.

Abstract

Introduction: Laparoscopic common bile duct exploration (LCBDE) is a critical procedure for managing choledocholithiasis, with primary closure (PC) and T-tube drainage (TTD) as common methods for common bile duct closure. However, the substantial number of new studies comparing PC and TTD underscores the need for an updated meta-analysis. Therefore, this study aims to compare surgery-related outcomes in PC and TTD for biliary duct closure following LCBDE. Methods: We searched PubMed, Embase, and Cochrane Library databases on June 20, 2024. Mean differences (MDs) and risk ratios with 95% confidence intervals (CIs) were pooled for continuous and binary outcomes, respectively. Heterogeneity was assessed with I² statistics. Statistical analysis was performed using Software R, version 4.3.3. Results: A total of 31 studies comprising 4432 patients were included. A total of 2301 (51.9%) were submitted to PC and 2131 (48.1%) were submitted to TTD. The mean age of patients ranged from 39 to 69.8 years and 44.3% were male. Compared with TTD, PC significantly reduced retained stones (odds ratio [OR] 0.57; 95% CI 0.35-0.93; P = .02; I² = 0%), biliary peritonitis (OR 0.22; 95% CI 0.08-0.60; P < .01; I² = 0%), operative time (MD -21.07 minutes; 95% CI -27.68-14.46; P <. 01; I² = 97%) and postoperative hospital stay (MD -2.20 days; 95% CI -2.80-1.60; P <. 01; I² = 96%). However, there were no significant differences between the groups in recurrent stones (OR 0.57; 95% CI 0.32-1.02; P = .06; I² = 0%), bile leakage (OR 0.89; 95% CI 0.65-1.23; P = .49; I² = 0%), bile duct stricture (OR 2.08; 95% CI 0.36-12.11; P = .42; I² = 0%), pneumonia (OR 1.38; 95% CI 0.66-2.88; P = .39; I² = 0%), and pancreatitis (OR 0.64; 95% CI 0.29-1.38; P = .25; I² = 0%). Conclusion: In this meta-analysis, PC was associated with decreased retained stones, biliary peritonitis, operative time, and postoperative hospital stay. However, no significant differences were observed for the other outcomes. These findings underscore PC as a safe and reliable method for bile duct closure following LCBDE.