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Evidence summaries

Primary Closure Versus T-Tube Drainage after Open Common Bile Duct Exploration

Primary closure after common bile duct exploration appears to be at least as safe and may be more safe than T-tube drainage. Level of evidence: "B"

A Cochrane review [Abstract] 1 included 6 studies with a total of 359 subjects. There was no significant difference in mortality between the two groups (4/178 (weighted percentage 1.2%) in the T-tube group versus 1/181 (0.6%) in the primary closure group; RR 2.25; 95% CI 0.55 to 9.25; six trials). There was no significant difference in the serious morbidity rate between the two groups (24/136 (weighted serious morbidity rate, 145 events per 1000 patients) in the T-tube group versus 9/136 (weighted serious morbidity rate, 66 events per 1000 patients) in the primary closure group; RR 2.19; 95% CI 0.98 to 4.91; four trials). Quality of life and return to work were not reported in any of the trials. The operating time was significantly longer in the T-tube drainage group compared with the primary closure group (MD 28.90 minutes; 95% CI 17.18 to 40.62 minutes; one trial). The hospital stay was significantly longer in the T-tube drainage group compared with the primary closure group (MD 4.72 days; 95% CI 0.83 days to 8.60 days; five trials).

Comment: The quality of evidence is downgraded by limitations in study quality.

    References

    • Gurusamy KS, Koti R, Davidson BR. T-tube drainage versus primary closure after open common bile duct exploration. Cochrane Database Syst Rev 2013;(6):CD005640. [PubMed].

Primary/Secondary Keywords