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Abstract: Objective: To compare biliary complications after biliary tract reconstruction with or without t-tube in orthotopic liver transplantation. Methods: Randomized control trials (RCTs) and comparative studies were identified by a computerized literature search of the Cochrane Library, MEDLINE (1966/1–2010/4), Scopus (1980/1–2010/4), ClinicalTrials.gov (2010/4), the Cochrane Hepato-Biliary Group Controlled Trials Register, and the Cochrane Central Register of Controlled Trials. Studies and data were extracted and assessed independently. Dichotomous outcomes were reported as odds ratios (ORs) and weighted mean difference with 95% confidence intervals (CI). Results: Five RCTs and eight comparative studies with a total of 1 608 subjects were identified. The data showed that the operation with t-tube had better outcomes for duct stenosis (P=0.01, OR=0.45, 95% CI 0.24–0.85). The operations with or without t-tube had equivalent outcomes as follows: overall biliary complications (P=0.85, OR=1.15, 95% CI 0.28–4.72), bile leaks (P=0.38, OR=0.75, 95% CI 0.39–1.42), and cholangitis (P=0.24, OR=4.64, 95% CI 0.36–60.62). These results were strengthened by the analysis of all thirteen non-randomized and randomized studies. Conclusions: Our systematic review and meta-analysis suggest that the insertion of a t-tube reduces the incidence of biliary stenosis without increasing the incidence of other biliary complications.

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