Zhao JZ, Qiao LL, Du ZQ, Zhang J, Wang MZ, Wang T, Liu WM, Zhang L, Dong J, Wu Z, Wu RQ. T-tube vs no T-tube for biliary tract reconstruction in adult orthotopic liver transplantation: An updated systematic review and meta-analysis. World J Gastroenterol 2021; 27(14): 1507-1523 [PMID: 33911471 DOI: 10.3748/wjg.v27.i14.1507]
Corresponding Author of This Article
Rong-Qian Wu, MD, PhD, Professor, National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital of Xi’an Jiaotong University, No. 76 West Yanta Road, Xi’an 710061, Shaanxi Province, China. rwu001@mail.xjtu.edu.cn
Research Domain of This Article
Surgery
Article-Type of This Article
Meta-Analysis
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Apr 14, 2021; 27(14): 1507-1523 Published online Apr 14, 2021. doi: 10.3748/wjg.v27.i14.1507
T-tube vs no T-tube for biliary tract reconstruction in adult orthotopic liver transplantation: An updated systematic review and meta-analysis
Jun-Zhou Zhao, Lin-Lan Qiao, Zhao-Qing Du, Jia Zhang, Meng-Zhou Wang, Tao Wang, Wu-Ming Liu, Lin Zhang, Jian Dong, Zheng Wu, Rong-Qian Wu
Jun-Zhou Zhao, Lin-Lan Qiao, Zhao-Qing Du, Jia Zhang, Meng-Zhou Wang, Tao Wang, Wu-Ming Liu, Lin Zhang, Jian Dong, Zheng Wu, Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Jun-Zhou Zhao, Lin-Lan Qiao, Zhao-Qing Du, Jia Zhang, Rong-Qian Wu, National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Author contributions: All authors contributed to the study; Zhao JZ participated in the search strategy design and performed most statistical analyses and paper writing; Qiao LL, Du ZQ, and Zhang J did a literature search of the databases in parallel, built up selection criteria, and selected the potential studies; Wang MZ and Wang T defined the interventions and outcomes; Liu WM, Zhang L, and Dong J assessed the studies’ quality and figured out the characteristics of the selected studies; Wu Z assisted with the design of the study; Wu RQ designed and supervised the study and revised the manuscript.
Supported byNational Natural Science Foundation of China, No. 81770491; and The Innovation Capacity Support Plan of Shaanxi Province, No. 2020TD-040.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist and finished the manuscripts according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Rong-Qian Wu, MD, PhD, Professor, National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital of Xi’an Jiaotong University, No. 76 West Yanta Road, Xi’an 710061, Shaanxi Province, China. rwu001@mail.xjtu.edu.cn
Received: December 3, 2020 Peer-review started: December 3, 2020 First decision: December 21, 2020 Revised: December 29, 2020 Accepted: March 18, 2021 Article in press: March 18, 2021 Published online: April 14, 2021
ARTICLE HIGHLIGHTS
Research background
The use of the T-tube in the reconstruction of the biliary tree during orthotopic liver transplantation (OLT) is still debatable.
Research motivation
Biliary complications after OLT, including bile leaks, cholangitis, and biliary strictures, prolonged the hospital stay, impaired the postoperative recovery, and increased the medical costs. T-tube was involved in the occurrence of these biliary complications. Therefore, it is helpful to identify the role of T-tube in the incidence of the biliary complications.
Research objectives
We performed a meta-analysis to evaluate whether patients benefit from the use of a T-tube during OLT.
Research methods
We calculated odds ratios with 95% confidence intervals to identify the role of a T-tube in the incidence of the overall biliary complications, bile leaks, cholangitis, and biliary strictures.
Research results
We discovered that T-tube had no influence on the risk of the overall biliary complications, bile leaks, and cholangitis and reduced the incidence of biliary strictures in the period from 1995 to 2010. However, in the recent decade (from 2010 to 2020), we found that T-tube did not affect the occurrence of biliary strictures and increased the incidence of overall biliary complications and cholangitis. And the use of a T-tube showed an unbeneficial trend for bile leak after 2010.
Research conclusions
In conclusion, the evidence gathered in our updated meta-analysis showed that the studies published in the last decade did not provide enough evidence to support the routine use of T-tube in adults during OLT.
Research perspectives
More T-tube-related outcomes should be included in the future meta-analysis so the advantages and disadvantages would be evaluated better.
