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

Abstract

Abstract:

ObjectiveTo systematically evaluate the comparative efficacy of primary closureversusT-tube drainage following laparoscopic common bile duct exploration (LCBDE) and extraction combined with cholecystectomy in the management of choledocholithiasis with concomitant cholecystolithiasis.MethodsA 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.ResultsTen studies involving 1 589 patients (783 primary closurevs. 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].ConclusionsBoth 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)

CLC Number:

R657.42

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.

Figures/Tables13

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Tab 1

Summary of included literature information

Inclusion study	Year of publi- cation	Research time	Closing mode	case- load	Male/fe- male (e-xample)	Operation time (min)	Intraoperative blood loss（mL）	Extubation time（d）	Gastrointestinal reco-very time (d)	Total post operative hospital stay (d)	Total hospital expenses (Yuan)	Bile leakage	pancreati- tis	Stone residue	Recurrence of stone	stricture
HUANG Bo,et al	2021	2014-2019	PC	50	30/20	91.24±8.18	23.92±5.78	4.90±0.81	2.41±0.49	-	-	4	-	1	1	-
			TD	82	47/35	98.68±10.20	25.02±6.57	4.43±0.65	2.54±0.53	-	-	1	-	2	10	-
LI Wenxin,et al	2019	2015-2017	PC	33	22/11	99.61±11.7	67.92±14.58	-	2.58±0.59	-	24 600±2 900	1	1	1	1	-
			TD	37	24/13	102.34±10.46	69.64±15.24	-	4.23±0.81	-	24 900±3 200	4	0	2	0	-
LIAN Yuanshu,et al	2020	2015-2019	PC	48	21/27	-	-	3.5±0.3	0.6±0.1	-	-	1	-	0	2	-
			TD	52	26/26	-	-	4.3±0.4	0.7±0.1	-	-	3	-	2	4	-
LIANG Kuo,et al	2017	2012-2016	PC	63	29/34	86.5±21.5	28.6±22	4.3±3.8	-	7.6±4.3	-	8	-	2	-	-
			TD	52	30/22	94.4±20.3	36.2±27.2	4.4±1.6	-	10.9±6.6	-	1	-	5	-	-
MA Daxi,et al	2018	2014-2016	PC	89	54/35	108.25±34.91	26.56±10.18	-	-	7.48±3.17	21 200±5 500	7	1	2	-	1
			TD	88	42/46	131.06±67.29	29.57±11.11	-	-	7.61±2.48	24 100±7 100	4	1	3	-	0
SHEN Biao,et al	2018	2012-2016	PC	204	118/86	94.27±24.34	25.11±6.37	2.71±1.09	0.87±0.26	5.91±1.08	-	6	-	-	-	3
			TD	204	112/92	133.25±45.78	39.17±5.84	3.44±1.53	1.26±0.31	7.07±1.42	-	4	-	-	-	4
ZHANG Weijie,et al	2015	2000-2009	PC	47	22/25	106.0±22.6	-	-	-	5.1±1.6	10 317.3±735.8	2	1	3	-	-
			TD	46	19/27	126.4±29.5	-	-	-	8.4±2.8	11 634.3±1 133.3	7	0	1	-	-
DONG Zhitao,et al	2014	2002-2012	PC	101	43/58	102.6±15.2	35.2±14.5	-	0.89±0.23	3.2±2.1	112 78.9±479.1	5	1	4	-	-
			TD	93	40/53	128.6±20.4	45.2±17.4	-	1.08±0.41	4.9±3.2	12 436.7±879.3	4	0	3	-	-
XIAO Lin-kang,et al	2018	2014-2016	PC	114	58/56	105.46±5.77	-	-	-	7.60±0.80	21 927.20±772.02	3	-	-	-	0
			TD	116	62/54	106.71±5.19	-	-	-	7.79±0.85	22 059.90±697.98	2	-	-	-	0
LI Zhiyu,et al	2015	2013-2014	PC	34	15/19	109.6±35.8	-	-	2.4±0.8	-	26 258.9±4 168.2	4	-	0	0	0
			TD	36	14/22	127.3±34.0	-	-	2.6±0.9	-	27 844.4±8 714.9	4	-	1	1	1

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