Primary closure versus T-tube drainage after common bile duct exploration for choledocholithiasis

The aim of this study was to evaluate the benefits and harms of primary closure versus T-tube drainage after common bile duct (CBD) exploration for choledocholithiasis. A literature search of MEDLINE (PubMed), EMBASE, and the Cochrane Library was done to identify randomized controlled trials assessing the benefits and harms of primary closure versus T-tube drainage after CBD exploration from Jan. 1990 to Apr. 2010. A meta-analysis was set up to distinguish overall difference between the primary closure and the T-tube drainage group. There were statistically significant differences between groups: biliary complications (odds ratio (OR) 95% confidence interval (CI), 0.42 (0.19-0.92); P = 0.03), main complications (OR 95% CI, 0.46 (0.23-0.90); P = 0.02), operating time (weighted mean difference (WMD) 95% CI, -19.53 (-29.35 to -9.71); P < 0.0001), and hospital stay (WMD 95% CI, -4.16 (-7.07 to -1.24); P = 0.005) except peri-operative mortality (OR 95% CI, 0.83 (0.11-6.37); P = 0.86), residual stones (OR 95% CI, 0.70 (0.22-2.25); P = 0.55), and abdominal collections (OR 95% CI, 1.93 (0.34-10.76); P = 0.46). And the result of wound infection (OR 95% CI, 0.38 (0.14-1.02); P = 0.05) tended to favor the primary closure group. The primary closure might be as effective as T-tube drainage after choledochotomy in the prevention of the development of post-operative complications.