T-tube or no T-tube in the reconstruction of the biliary tract during orthotopic liver transplantation: Systematic review and meta-analysis

Abstract

The routine use of a T-tube in reconstruction of the biliary tree during orthotopic liver transplantation (OLT) is controversial. A systematic review of the literature on the use of a T-tube in reconstruction of the biliary tree was performed. Retrospective studies were only reviewed, whereas prospective randomized studies were included in the meta-analysis. An analysis of 196 studies revealed that 91 studies investigated the use of a T-tube in OLT. Fifteen retrospective studies compared different groups and were thus considered relevant; 6 prospective studies were identified, of which 5 were randomized controlled trials with a total of 639 patients. The results of the randomized controlled trials were meta-analyzed. The odds ratio (OR) for biliary complications was 1.15 [95% confidence interval (CI) = 0.28-4.72], and this revealed that there were no differences in the rate of overall biliary complications whether or not a T-tube was used (Z = 0.19, P = 0.85). A detailed analysis of the biliary complications revealed that biliary leaks developed in 24 patients in the T-tube group versus 22 patients in the no-T-tube group (OR = 1.17, 95% CI = 0.4-3.47, Z = 0.29, P = 0.77). Biliary strictures were significantly more common in the group of patients who underwent reconstruction without a T-tube (14 versus 31 events; OR = 0.46, 95% CI = 0.23-0.9, Z = 2.26, P = 0.02). In conclusion, although reconstruction of the biliary tree with a T-tube prevents the occurrence of biliary strictures and may have the potential to reduce long-term morbidity with respect to late strictures, there is no clear evidence in favor of using a T-tube during OLT. © 2010 AASLD.