Complications of biliary stenting versus T-tube insertion after common bile duct exploration: A systematic review and meta-analysis

• Published in: PloS one 2023-01, Vol.18 (1), p.e0280755-e0280755
• Main Authors: Rudiman, Reno, Hanafi, Ricarhdo Valentino, Almawijaya, Halim, Freda
• Format: Article
• Language: English
• Subjects: Analysis; Bias; Bile ducts; Biliary Tract Surgical Procedures - adverse effects; Biliary Tract Surgical Procedures - methods; Biology and Life Sciences; Choledocholithiasis - surgery; Clinical trials; Cohort analysis; Common Bile Duct - surgery; Complications; Developing countries; Drainage - adverse effects; Drainage - methods; Endoscopic retrograde cholangiopancreatography; Exploration; Health aspects; Humans; Implants; Infections; Insertion; Laparoscopy; Laparoscopy - adverse effects; LDCs; Learning curves; Length of Stay; Medical research; Medicine and Health Sciences; Medicine, Experimental; Meta-analysis; Methods; Pancreatitis; Peritonitis; Physical Sciences; Postoperative; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - surgery; Qualitative analysis; Research and Analysis Methods; Retrospective Studies; Standard deviation; Stent (Surgery); Stents; Stents - adverse effects; Surgery; Surgical drains; Wound drainage
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0280755

Complications following the insertion T-tube or stent after common bile duct exploration (CBDE) remain problematic in nowadays surgical era. Based on our knowledge, we did not find any meta-analysis intentionally evaluating the complications between both groups. At this moment, we aimed to analyze and compare both procedures' complications, efficacy, efficiency, and feasibility. We searched literature from four databases (EuroPMC, PubMed, Scopus, and ClinicalTrials.gov) up to June 2022 to compile the randomized controlled trials and pro-/retrospective cohort studies. Review Manager 5.4 was used to statistically analyze each outcome measured between biliary stenting and T-tube insertion. Sixteen studies with 1,080 patients (534 biliary stents and 546 T-tube) were included for qualitative and quantitative analysis. The pooled risk ratio (RR) of the overall postoperative complications rate was significantly lower in the biliary stent group compared to the T-tube group 0.43 [95% confidence interval (CI) 0.23-0.80, p = 0.007]. In terms of the operation time, length of hospital stay, and readmission rate was also decreased in stenting as biliary drainage over T-tube placement 1.02 minutes [95% CI -1.53, -0.52, p < 0.0001], 1.96 days [95% CI -2.63, -1.29, p < 0.00001], and RR 0.39 [95% CI 0.15-0.97, p = 0.04], respectively. Stenting as biliary drainage after CBDE was superior to T-tube insertion. A shorter operation time and hospital stay in biliary drainage resulted in a lower overall postoperative complication rate. Other influences, including the complexity and shorter learning curve, might also affect the superiority of biliary stenting.