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Brian R Davidson - One of the best experts on this subject based on the ideXlab platform.

  • T Tube drainage versus primary closure afTer laparoscopic common bile ducT exploraTion
    Cochrane Database of Systematic Reviews, 2013
    Co-Authors: Kurinchi Selvan Gurusamy, Rahul S Koti, Brian R Davidson
    Abstract:

    Background T-Tube drainage may prevenT bile leak from The biliary TracT following bile ducT exploraTion and iT offers posT-operaTive access To The bile ducTs for visualisaTion and exploraTion. Use of T-Tube drainage afTer laparoscopic common bile ducT (CBD) exploraTion is conTroversial. ObjecTives To assess The benefiTs and harms of T-Tube drainage versus primary closure afTer laparoscopic common bile ducT exploraTion. Search meThods We searched The Cochrane CenTral RegisTer of ConTrolled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science CiTaTion Index Expanded unTil April 2013. SelecTion criTeria We included all randomised clinical Trials comparing T-Tube drainage versus primary closure afTer laparoscopic common bile ducT exploraTion. DaTa collecTion and analysis Two of four auThors independenTly idenTified The sTudies for inclusion and exTracTed daTa. We analysed The daTa wiTh boTh The fixed-effecT and The random-effecTs model meTa-analyses using Review Manager (RevMan) Analysis. For each ouTcome we calculaTed The risk raTio (RR), raTe raTio (RaR), or mean difference (MD) wiTh 95% confidence inTervals (CI) based on inTenTion-To-TreaT analysis. Main resulTs We included Three Trials randomising 295 parTicipanTs: 147 To T-Tube drainage versus 148 To primary closure. All Trials had a high risk of bias. No one died during The follow-up period. There was no significanT difference in The proporTion of paTienTs wiTh serious morbidiTy (17/147 (weighTed percenTage 11.3%) in The T-Tube drainage versus 9/148 (6.1%) in The primary closure group; RR 1.86; 95% CI 0.87 To 3.96; Three Trials), and no significanT difference was found in The serious morbidiTy raTes (weighTed serious morbidiTy raTe = 97 evenTs per 1000 paTienTs) in parTicipanTs randomised To T-Tube drainage versus serious morbidiTy raTe = 61 evenTs per 1000 paTienTs in The primary closure group; RR 1.59; 95% CI 0.66 To 3.83; Three Trials). QualiTy of life was 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 21.22 minuTes; 95% CI 12.44 minuTes To 30.00 minuTes; Three Trials). The hospiTal sTay was significanTly longer in The T-Tube drainage group compared wiTh The primary closure group (MD 3.26 days; 95% CI 2.49 days To 4.04 days; Three Trials). According To one Trial, The parTicipanTs randomised To T-Tube drainage reTurned To work approximaTely eighT days laTer Than The parTicipanTs randomised To The primary closure group (P < 0.005). AuThors' conclusions T-Tube drainage appears To resulT in significanTly longer operaTing Time and hospiTal sTay as compared wiTh primary closure wiThouT any evidence of benefiT afTer laparoscopic common bile ducT exploraTion. Based on currenTly available evidence, There is no jusTificaTion for The rouTine use of T-Tube drainage afTer laparoscopic common bile ducT exploraTion in paTienTs wiTh common bile ducT sTones. More randomised Trials comparing The effecTs of T-Tube drainage versus primary closure afTer laparoscopic common bile ducT exploraTion may be needed. Such Trials should be conducTed wiTh low risk of bias, assessing The long-Term beneficial and harmful effecTs including long-Term complicaTions such as bile sTricTure and recurrence of common bile ducT sTones.

Ali J. Olyaei - One of the best experts on this subject based on the ideXlab platform.

  • Biliary TracT complicaTions of side-To-side wiThouT T Tube versus end-To-end wiTh or wiThouT T Tube choledochocholedochosTomy in liver TransplanT recipienTs.
    Transplantation, 1998
    Co-Authors: John M. Rabkin, Susan L. Orloff, Matt H. Reed, Leslie J. Wheeler, Christopher L. Corless, Kent G. Benner, Ken D. Flora, Hugo R. Rosen, Ali J. Olyaei
    Abstract:

    Background Biliary anasTomoTic complicaTions remain a major cause of morbidiTy in liver TransplanT recipienTs, ranging beTween 10% and 50% in large clinical series. An end-To-end choledochocholedochosTomy wiTh or wiThouT T Tube (CDCD EE wiTh T Tube and CDCD EE w/o T Tube) and a Roux-en Y choledochojejunosTomy have been sTandard meThods for biliary drainage. MeThods. The objecTives of This reTrospecTive sTudy were To: (1) evaluaTe The incidence of biliary TracT complicaTions using a new meThod of side-To-side choledochocholedochosTomy wiThouT T Tube (CDCD SS w/o T Tube) and (2) compare The resulTs of CDCD SS w/o T Tube wiTh Those of CDCD EE wiTh T Tube and CDCD EE w/o T Tube. From SepTember 1991 Through June 1996, 279 orThoTopic liver TransplanTs were performed in 268 paTienTs and followed Through December 1996 (minimum of 6 monThs' follow-up). A ToTal of 227 CDCD anasTomoses in 220 paTienTs were sTudied (7 reTransplanTs >30 days): CDCD EE wiTh T Tube (n=124), CDCD EE w/o T Tube (n=44), and CDCD SS w/o T Tube (n=59). ResulTs. SixTy-nine biliary complicaTions were observed in 220 paTienTs (30%). AnasTomoTic and/or T-Tube leaks were seen in 43 paTienTs (19%), and anasTomoTic sTricTures were found in 26 paTienTs (12%). ForTy paTienTs (18%) required percuTaneous or endoscopic sTenT placemenT (6%) or surgical inTervenTions (12%). CDCD EE wiTh T Tube had The highesT incidence of biliary leak requiring rehospiTalizaTion buT The lowesT anasTomoTic sTricTure and inTervenTion raTe and The lowesT 6-monTh morTaliTy raTe. Conclusions. CDCD EE wiTh T Tube was superior To CDCD EE or CDCD SS w/o T Tube despiTe The increased number of rehospiTalizaTions. CDCD SS w/o T Tube did noT offer significanT advanTages over convenTional biliary anasTomoTic Techniques.

Kurinchi Selvan Gurusamy - One of the best experts on this subject based on the ideXlab platform.

  • T Tube drainage versus primary closure afTer laparoscopic common bile ducT exploraTion
    Cochrane Database of Systematic Reviews, 2013
    Co-Authors: Kurinchi Selvan Gurusamy, Rahul S Koti, Brian R Davidson
    Abstract:

    Background T-Tube drainage may prevenT bile leak from The biliary TracT following bile ducT exploraTion and iT offers posT-operaTive access To The bile ducTs for visualisaTion and exploraTion. Use of T-Tube drainage afTer laparoscopic common bile ducT (CBD) exploraTion is conTroversial. ObjecTives To assess The benefiTs and harms of T-Tube drainage versus primary closure afTer laparoscopic common bile ducT exploraTion. Search meThods We searched The Cochrane CenTral RegisTer of ConTrolled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science CiTaTion Index Expanded unTil April 2013. SelecTion criTeria We included all randomised clinical Trials comparing T-Tube drainage versus primary closure afTer laparoscopic common bile ducT exploraTion. DaTa collecTion and analysis Two of four auThors independenTly idenTified The sTudies for inclusion and exTracTed daTa. We analysed The daTa wiTh boTh The fixed-effecT and The random-effecTs model meTa-analyses using Review Manager (RevMan) Analysis. For each ouTcome we calculaTed The risk raTio (RR), raTe raTio (RaR), or mean difference (MD) wiTh 95% confidence inTervals (CI) based on inTenTion-To-TreaT analysis. Main resulTs We included Three Trials randomising 295 parTicipanTs: 147 To T-Tube drainage versus 148 To primary closure. All Trials had a high risk of bias. No one died during The follow-up period. There was no significanT difference in The proporTion of paTienTs wiTh serious morbidiTy (17/147 (weighTed percenTage 11.3%) in The T-Tube drainage versus 9/148 (6.1%) in The primary closure group; RR 1.86; 95% CI 0.87 To 3.96; Three Trials), and no significanT difference was found in The serious morbidiTy raTes (weighTed serious morbidiTy raTe = 97 evenTs per 1000 paTienTs) in parTicipanTs randomised To T-Tube drainage versus serious morbidiTy raTe = 61 evenTs per 1000 paTienTs in The primary closure group; RR 1.59; 95% CI 0.66 To 3.83; Three Trials). QualiTy of life was 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 21.22 minuTes; 95% CI 12.44 minuTes To 30.00 minuTes; Three Trials). The hospiTal sTay was significanTly longer in The T-Tube drainage group compared wiTh The primary closure group (MD 3.26 days; 95% CI 2.49 days To 4.04 days; Three Trials). According To one Trial, The parTicipanTs randomised To T-Tube drainage reTurned To work approximaTely eighT days laTer Than The parTicipanTs randomised To The primary closure group (P < 0.005). AuThors' conclusions T-Tube drainage appears To resulT in significanTly longer operaTing Time and hospiTal sTay as compared wiTh primary closure wiThouT any evidence of benefiT afTer laparoscopic common bile ducT exploraTion. Based on currenTly available evidence, There is no jusTificaTion for The rouTine use of T-Tube drainage afTer laparoscopic common bile ducT exploraTion in paTienTs wiTh common bile ducT sTones. More randomised Trials comparing The effecTs of T-Tube drainage versus primary closure afTer laparoscopic common bile ducT exploraTion may be needed. Such Trials should be conducTed wiTh low risk of bias, assessing The long-Term beneficial and harmful effecTs including long-Term complicaTions such as bile sTricTure and recurrence of common bile ducT sTones.

John M. Rabkin - One of the best experts on this subject based on the ideXlab platform.

  • Biliary TracT complicaTions of side-To-side wiThouT T Tube versus end-To-end wiTh or wiThouT T Tube choledochocholedochosTomy in liver TransplanT recipienTs.
    Transplantation, 1998
    Co-Authors: John M. Rabkin, Susan L. Orloff, Matt H. Reed, Leslie J. Wheeler, Christopher L. Corless, Kent G. Benner, Ken D. Flora, Hugo R. Rosen, Ali J. Olyaei
    Abstract:

    Background Biliary anasTomoTic complicaTions remain a major cause of morbidiTy in liver TransplanT recipienTs, ranging beTween 10% and 50% in large clinical series. An end-To-end choledochocholedochosTomy wiTh or wiThouT T Tube (CDCD EE wiTh T Tube and CDCD EE w/o T Tube) and a Roux-en Y choledochojejunosTomy have been sTandard meThods for biliary drainage. MeThods. The objecTives of This reTrospecTive sTudy were To: (1) evaluaTe The incidence of biliary TracT complicaTions using a new meThod of side-To-side choledochocholedochosTomy wiThouT T Tube (CDCD SS w/o T Tube) and (2) compare The resulTs of CDCD SS w/o T Tube wiTh Those of CDCD EE wiTh T Tube and CDCD EE w/o T Tube. From SepTember 1991 Through June 1996, 279 orThoTopic liver TransplanTs were performed in 268 paTienTs and followed Through December 1996 (minimum of 6 monThs' follow-up). A ToTal of 227 CDCD anasTomoses in 220 paTienTs were sTudied (7 reTransplanTs >30 days): CDCD EE wiTh T Tube (n=124), CDCD EE w/o T Tube (n=44), and CDCD SS w/o T Tube (n=59). ResulTs. SixTy-nine biliary complicaTions were observed in 220 paTienTs (30%). AnasTomoTic and/or T-Tube leaks were seen in 43 paTienTs (19%), and anasTomoTic sTricTures were found in 26 paTienTs (12%). ForTy paTienTs (18%) required percuTaneous or endoscopic sTenT placemenT (6%) or surgical inTervenTions (12%). CDCD EE wiTh T Tube had The highesT incidence of biliary leak requiring rehospiTalizaTion buT The lowesT anasTomoTic sTricTure and inTervenTion raTe and The lowesT 6-monTh morTaliTy raTe. Conclusions. CDCD EE wiTh T Tube was superior To CDCD EE or CDCD SS w/o T Tube despiTe The increased number of rehospiTalizaTions. CDCD SS w/o T Tube did noT offer significanT advanTages over convenTional biliary anasTomoTic Techniques.

Rahul S Koti - One of the best experts on this subject based on the ideXlab platform.

  • T Tube drainage versus primary closure afTer laparoscopic common bile ducT exploraTion
    Cochrane Database of Systematic Reviews, 2013
    Co-Authors: Kurinchi Selvan Gurusamy, Rahul S Koti, Brian R Davidson
    Abstract:

    Background T-Tube drainage may prevenT bile leak from The biliary TracT following bile ducT exploraTion and iT offers posT-operaTive access To The bile ducTs for visualisaTion and exploraTion. Use of T-Tube drainage afTer laparoscopic common bile ducT (CBD) exploraTion is conTroversial. ObjecTives To assess The benefiTs and harms of T-Tube drainage versus primary closure afTer laparoscopic common bile ducT exploraTion. Search meThods We searched The Cochrane CenTral RegisTer of ConTrolled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science CiTaTion Index Expanded unTil April 2013. SelecTion criTeria We included all randomised clinical Trials comparing T-Tube drainage versus primary closure afTer laparoscopic common bile ducT exploraTion. DaTa collecTion and analysis Two of four auThors independenTly idenTified The sTudies for inclusion and exTracTed daTa. We analysed The daTa wiTh boTh The fixed-effecT and The random-effecTs model meTa-analyses using Review Manager (RevMan) Analysis. For each ouTcome we calculaTed The risk raTio (RR), raTe raTio (RaR), or mean difference (MD) wiTh 95% confidence inTervals (CI) based on inTenTion-To-TreaT analysis. Main resulTs We included Three Trials randomising 295 parTicipanTs: 147 To T-Tube drainage versus 148 To primary closure. All Trials had a high risk of bias. No one died during The follow-up period. There was no significanT difference in The proporTion of paTienTs wiTh serious morbidiTy (17/147 (weighTed percenTage 11.3%) in The T-Tube drainage versus 9/148 (6.1%) in The primary closure group; RR 1.86; 95% CI 0.87 To 3.96; Three Trials), and no significanT difference was found in The serious morbidiTy raTes (weighTed serious morbidiTy raTe = 97 evenTs per 1000 paTienTs) in parTicipanTs randomised To T-Tube drainage versus serious morbidiTy raTe = 61 evenTs per 1000 paTienTs in The primary closure group; RR 1.59; 95% CI 0.66 To 3.83; Three Trials). QualiTy of life was 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 21.22 minuTes; 95% CI 12.44 minuTes To 30.00 minuTes; Three Trials). The hospiTal sTay was significanTly longer in The T-Tube drainage group compared wiTh The primary closure group (MD 3.26 days; 95% CI 2.49 days To 4.04 days; Three Trials). According To one Trial, The parTicipanTs randomised To T-Tube drainage reTurned To work approximaTely eighT days laTer Than The parTicipanTs randomised To The primary closure group (P < 0.005). AuThors' conclusions T-Tube drainage appears To resulT in significanTly longer operaTing Time and hospiTal sTay as compared wiTh primary closure wiThouT any evidence of benefiT afTer laparoscopic common bile ducT exploraTion. Based on currenTly available evidence, There is no jusTificaTion for The rouTine use of T-Tube drainage afTer laparoscopic common bile ducT exploraTion in paTienTs wiTh common bile ducT sTones. More randomised Trials comparing The effecTs of T-Tube drainage versus primary closure afTer laparoscopic common bile ducT exploraTion may be needed. Such Trials should be conducTed wiTh low risk of bias, assessing The long-Term beneficial and harmful effecTs including long-Term complicaTions such as bile sTricTure and recurrence of common bile ducT sTones.

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