RESUMO
BACKGROUND: Common bile duct (CBD) stones may occur in up to 3%-14.7% of all patients with cholecystectomy. Various approaches of laparoscopic CBD exploration plus primary duct closure (PDC) are the most commonly used and the best methods to treat CBD stone. This systematic review was to compare the effectiveness and safety of the various approaches of laparoscopic CBD exploration plus PDC for choledocholithiasis. DATA SOURCES: Randomized controlled trials (RCTs) and non-randomized controlled trials (NRCTs) (case-control studies or cohort studies) were searched from Cochrane library (until Issue 2, 2015), Web of Science (1980-January 2016), PubMed (1966-January 2016), and Baidu search engine. After independent quality assessment and data extraction, meta-analysis was conducted using RevMan 5.1 software. RESULTS: Four RCTs and 18 NRCTs were included. When compared with choledochotomy exploration (CE) plus T-tube drainage (TTD) (CEâ¯+â¯TTD), CE plus PDC (CEâ¯+â¯PDC) and CEâ¯+â¯PDC with biliary drainage (BD) (CEâ¯+â¯PDCâ¯+â¯BD) had a lower rate of postoperative biliary peritonitis (ORâ¯=â¯0.22; 95% CI: 0.06, 0.88; Pâ¯<â¯0.05; ORâ¯=â¯0.27; 95% CI: 0.08, 0.84; Pâ¯<â¯0.05; respectively) where T-tubes were removed more than 3 weeks. The operative time of CEâ¯+â¯PDC was significantly shorter (WMDâ¯=â¯-24.82; 95% CI: -27.48, -22.16; Pâ¯<â¯0.01) than that of CEâ¯+â¯TTD in RCTs. Cystic duct exploration (CDE) plus PDC (CDEâ¯+â¯PDC) has a lower rate of postoperative complications (ORâ¯=â¯0.39; 95% CI: 0.23, 0.67; Pâ¯<â¯0.01) when compared with CEâ¯+â¯PDC. Confluence part micro-incision exploration (CME) plus PDC (CMEâ¯+â¯PDC) has a lower rate of postoperative bile leakage (ORâ¯=â¯0.17; 95% CI: 0.04, 0.74; Pâ¯<â¯0.05) when compared with CEâ¯+â¯PDC. CONCLUSION: PDC with other various approaches are better than TTD in the treatment of choledocholithiasis.