The role of T‐tubes and abdominal drains on short‐term outcomes in liver transplantation – A systematic review of the literature and expert panel recommendations
Background This systematic review and expert panel recommendation aims to answer the question regarding the routine use of T‐tubes or abdominal drains to better manage complications and thereby improve outcomes after liver transplantation. Methods Systematic review following PRISMA guidelines and re...
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Veröffentlicht in: | Clinical transplantation 2022-10, Vol.36 (10), p.e14719-n/a |
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creator | Kalisvaart, Marit Jonge, Jeroen Abt, Peter Orloff, Susan Muiesan, Paolo Florman, Sander Spiro, Michael Raptis, Dimitri Aristotle Eghtesad, Bijan |
description | Background
This systematic review and expert panel recommendation aims to answer the question regarding the routine use of T‐tubes or abdominal drains to better manage complications and thereby improve outcomes after liver transplantation.
Methods
Systematic review following PRISMA guidelines and recommendations using the GRADE approach derived from an international expert panel to assess the potential risks and benefits of T‐tubes and intra‐abdominal drainage in liver transplantation (CRD42021243036).
Results
Of the 2996 screened records, 33 studies were included in the systematic review, of which 29 (six RCTs) assessed the use of T‐tubes and four regarding surgical drains. Although some studies reported less strictures when using a T‐tube, there was a trend toward more biliary complications with T‐tubes, mainly related to biliary leakage. Due to the small number of studies, there was a paucity of evidence on the effect of abdominal drains with no clear benefit for or against the use of drainage. However, one study investigating the open vs. closed circuit drains found a significantly higher incidence of intra‐abdominal infections when open‐circuit drains were used.
Conclusions
Due to the potential risk of biliary leakage and infections, the routine intraoperative insertion of T‐tubes is not recommended (Level of Evidence moderate ‐ very low; grade of recommendation strong). However, a T‐tube can be considered in cases at risk for biliary stenosis. Due to the scant evidence on abdominal drainage, no change in clinical practice in individual centers is recommended. (Level of Evidence very low; weak recommendation). |
doi_str_mv | 10.1111/ctr.14719 |
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This systematic review and expert panel recommendation aims to answer the question regarding the routine use of T‐tubes or abdominal drains to better manage complications and thereby improve outcomes after liver transplantation.
Methods
Systematic review following PRISMA guidelines and recommendations using the GRADE approach derived from an international expert panel to assess the potential risks and benefits of T‐tubes and intra‐abdominal drainage in liver transplantation (CRD42021243036).
Results
Of the 2996 screened records, 33 studies were included in the systematic review, of which 29 (six RCTs) assessed the use of T‐tubes and four regarding surgical drains. Although some studies reported less strictures when using a T‐tube, there was a trend toward more biliary complications with T‐tubes, mainly related to biliary leakage. Due to the small number of studies, there was a paucity of evidence on the effect of abdominal drains with no clear benefit for or against the use of drainage. However, one study investigating the open vs. closed circuit drains found a significantly higher incidence of intra‐abdominal infections when open‐circuit drains were used.
Conclusions
Due to the potential risk of biliary leakage and infections, the routine intraoperative insertion of T‐tubes is not recommended (Level of Evidence moderate ‐ very low; grade of recommendation strong). However, a T‐tube can be considered in cases at risk for biliary stenosis. Due to the scant evidence on abdominal drainage, no change in clinical practice in individual centers is recommended. (Level of Evidence very low; weak recommendation).</description><identifier>ISSN: 0902-0063</identifier><identifier>EISSN: 1399-0012</identifier><identifier>DOI: 10.1111/ctr.14719</identifier><identifier>PMID: 35596705</identifier><language>eng</language><publisher>Denmark: John Wiley and Sons Inc</publisher><subject>Abdomen - surgery ; abdominal drainage ; biliary complications ; biliary leakage ; biliary strictures ; Biliary Tract Diseases ; complications ; Drainage ; Humans ; liver transplantation ; Liver Transplantation - adverse effects ; Original ; outcomes ; Postoperative Complications ; T‐tubes</subject><ispartof>Clinical transplantation, 2022-10, Vol.36 (10), p.e14719-n/a</ispartof><rights>2022 The Authors. published by John Wiley & Sons Ltd.</rights><rights>2022 The Authors. Clinical Transplantation published by John Wiley & Sons Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4169-ac4dc8b3347dcf1f51014d879a7fabfd5660339da33b4d3b20ad4898308911f33</citedby><cites>FETCH-LOGICAL-c4169-ac4dc8b3347dcf1f51014d879a7fabfd5660339da33b4d3b20ad4898308911f33</cites><orcidid>0000-0002-1635-9136 ; 0000-0002-7857-0092</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fctr.14719$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fctr.14719$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>230,315,781,785,886,1418,27929,27930,45579,45580</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35596705$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kalisvaart, Marit</creatorcontrib><creatorcontrib>Jonge, Jeroen</creatorcontrib><creatorcontrib>Abt, Peter</creatorcontrib><creatorcontrib>Orloff, Susan</creatorcontrib><creatorcontrib>Muiesan, Paolo</creatorcontrib><creatorcontrib>Florman, Sander</creatorcontrib><creatorcontrib>Spiro, Michael</creatorcontrib><creatorcontrib>Raptis, Dimitri Aristotle</creatorcontrib><creatorcontrib>Eghtesad, Bijan</creatorcontrib><creatorcontrib>ERAS4OLT.org working group</creatorcontrib><creatorcontrib>ERAS4OLT.org working group</creatorcontrib><title>The role of T‐tubes and abdominal drains on short‐term outcomes in liver transplantation – A systematic review of the literature and expert panel recommendations</title><title>Clinical transplantation</title><addtitle>Clin Transplant</addtitle><description>Background
This systematic review and expert panel recommendation aims to answer the question regarding the routine use of T‐tubes or abdominal drains to better manage complications and thereby improve outcomes after liver transplantation.
Methods
Systematic review following PRISMA guidelines and recommendations using the GRADE approach derived from an international expert panel to assess the potential risks and benefits of T‐tubes and intra‐abdominal drainage in liver transplantation (CRD42021243036).
Results
Of the 2996 screened records, 33 studies were included in the systematic review, of which 29 (six RCTs) assessed the use of T‐tubes and four regarding surgical drains. Although some studies reported less strictures when using a T‐tube, there was a trend toward more biliary complications with T‐tubes, mainly related to biliary leakage. Due to the small number of studies, there was a paucity of evidence on the effect of abdominal drains with no clear benefit for or against the use of drainage. However, one study investigating the open vs. closed circuit drains found a significantly higher incidence of intra‐abdominal infections when open‐circuit drains were used.
Conclusions
Due to the potential risk of biliary leakage and infections, the routine intraoperative insertion of T‐tubes is not recommended (Level of Evidence moderate ‐ very low; grade of recommendation strong). However, a T‐tube can be considered in cases at risk for biliary stenosis. Due to the scant evidence on abdominal drainage, no change in clinical practice in individual centers is recommended. (Level of Evidence very low; weak recommendation).</description><subject>Abdomen - surgery</subject><subject>abdominal drainage</subject><subject>biliary complications</subject><subject>biliary leakage</subject><subject>biliary strictures</subject><subject>Biliary Tract Diseases</subject><subject>complications</subject><subject>Drainage</subject><subject>Humans</subject><subject>liver transplantation</subject><subject>Liver Transplantation - adverse effects</subject><subject>Original</subject><subject>outcomes</subject><subject>Postoperative Complications</subject><subject>T‐tubes</subject><issn>0902-0063</issn><issn>1399-0012</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><sourceid>EIF</sourceid><recordid>eNp1kU9uGyEUh1HVqnHdLnqBimW7cAJmhhlWVWT1nxQpUuWuEQNvaioGpsA49S5HqNRD9F45SbGdRM0ibECPT98P3kPoNSWntKwzneMprRoqnqAZZUIsCKHLp2hGBFmWM2cn6EVKP0qVU14_RyesrgVvSD1Df9cbwDE4wKHH65vr33nqIGHlDVadCYP1ymETlfUJB4_TJsS8pyAOOExZh6HQ1mNntxBxjsqn0SmfVbYFv7n-g89x2qUMQ6loHGFr4WqflUuus8Wj8hThEAi_RogZj8qDK2RxD-DNwZReome9cgle3e5z9O3jh_Xq8-Li8tOX1fnFQleUi4XSldFtx1jVGN3TvqaEVqZthGp61fWm5pwwJoxirKsM65ZEmaoVLSOtoLRnbI7eH73j1A1gNPjyJyfHaAcVdzIoKx_eeLuR38NWUkKadt_rOXp7a4jh5wQpy8EmDa50BcKU5JLzpmlbwpqCvjuiOoaUIvT3OZTI_WRlmaw8TLawb_5_2D15N8oCnB2BK-tg97hJrtZfj8p_04O1Pg</recordid><startdate>202210</startdate><enddate>202210</enddate><creator>Kalisvaart, Marit</creator><creator>Jonge, Jeroen</creator><creator>Abt, Peter</creator><creator>Orloff, Susan</creator><creator>Muiesan, Paolo</creator><creator>Florman, Sander</creator><creator>Spiro, Michael</creator><creator>Raptis, Dimitri Aristotle</creator><creator>Eghtesad, Bijan</creator><general>John Wiley and Sons Inc</general><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-1635-9136</orcidid><orcidid>https://orcid.org/0000-0002-7857-0092</orcidid></search><sort><creationdate>202210</creationdate><title>The role of T‐tubes and abdominal drains on short‐term outcomes in liver transplantation – A systematic review of the literature and expert panel recommendations</title><author>Kalisvaart, Marit ; Jonge, Jeroen ; Abt, Peter ; Orloff, Susan ; Muiesan, Paolo ; Florman, Sander ; Spiro, Michael ; Raptis, Dimitri Aristotle ; Eghtesad, Bijan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4169-ac4dc8b3347dcf1f51014d879a7fabfd5660339da33b4d3b20ad4898308911f33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Abdomen - surgery</topic><topic>abdominal drainage</topic><topic>biliary complications</topic><topic>biliary leakage</topic><topic>biliary strictures</topic><topic>Biliary Tract Diseases</topic><topic>complications</topic><topic>Drainage</topic><topic>Humans</topic><topic>liver transplantation</topic><topic>Liver Transplantation - adverse effects</topic><topic>Original</topic><topic>outcomes</topic><topic>Postoperative Complications</topic><topic>T‐tubes</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kalisvaart, Marit</creatorcontrib><creatorcontrib>Jonge, Jeroen</creatorcontrib><creatorcontrib>Abt, Peter</creatorcontrib><creatorcontrib>Orloff, Susan</creatorcontrib><creatorcontrib>Muiesan, Paolo</creatorcontrib><creatorcontrib>Florman, Sander</creatorcontrib><creatorcontrib>Spiro, Michael</creatorcontrib><creatorcontrib>Raptis, Dimitri Aristotle</creatorcontrib><creatorcontrib>Eghtesad, Bijan</creatorcontrib><creatorcontrib>ERAS4OLT.org working group</creatorcontrib><creatorcontrib>ERAS4OLT.org working group</creatorcontrib><collection>Wiley Online Library Open Access</collection><collection>Wiley Online Library Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kalisvaart, Marit</au><au>Jonge, Jeroen</au><au>Abt, Peter</au><au>Orloff, Susan</au><au>Muiesan, Paolo</au><au>Florman, Sander</au><au>Spiro, Michael</au><au>Raptis, Dimitri Aristotle</au><au>Eghtesad, Bijan</au><aucorp>ERAS4OLT.org working group</aucorp><aucorp>ERAS4OLT.org working group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The role of T‐tubes and abdominal drains on short‐term outcomes in liver transplantation – A systematic review of the literature and expert panel recommendations</atitle><jtitle>Clinical transplantation</jtitle><addtitle>Clin Transplant</addtitle><date>2022-10</date><risdate>2022</risdate><volume>36</volume><issue>10</issue><spage>e14719</spage><epage>n/a</epage><pages>e14719-n/a</pages><issn>0902-0063</issn><eissn>1399-0012</eissn><abstract>Background
This systematic review and expert panel recommendation aims to answer the question regarding the routine use of T‐tubes or abdominal drains to better manage complications and thereby improve outcomes after liver transplantation.
Methods
Systematic review following PRISMA guidelines and recommendations using the GRADE approach derived from an international expert panel to assess the potential risks and benefits of T‐tubes and intra‐abdominal drainage in liver transplantation (CRD42021243036).
Results
Of the 2996 screened records, 33 studies were included in the systematic review, of which 29 (six RCTs) assessed the use of T‐tubes and four regarding surgical drains. Although some studies reported less strictures when using a T‐tube, there was a trend toward more biliary complications with T‐tubes, mainly related to biliary leakage. Due to the small number of studies, there was a paucity of evidence on the effect of abdominal drains with no clear benefit for or against the use of drainage. However, one study investigating the open vs. closed circuit drains found a significantly higher incidence of intra‐abdominal infections when open‐circuit drains were used.
Conclusions
Due to the potential risk of biliary leakage and infections, the routine intraoperative insertion of T‐tubes is not recommended (Level of Evidence moderate ‐ very low; grade of recommendation strong). However, a T‐tube can be considered in cases at risk for biliary stenosis. Due to the scant evidence on abdominal drainage, no change in clinical practice in individual centers is recommended. (Level of Evidence very low; weak recommendation).</abstract><cop>Denmark</cop><pub>John Wiley and Sons Inc</pub><pmid>35596705</pmid><doi>10.1111/ctr.14719</doi><tpages>13</tpages><orcidid>https://orcid.org/0000-0002-1635-9136</orcidid><orcidid>https://orcid.org/0000-0002-7857-0092</orcidid><oa>free_for_read</oa></addata></record> |
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source | MEDLINE; Wiley Online Library All Journals |
subjects | Abdomen - surgery abdominal drainage biliary complications biliary leakage biliary strictures Biliary Tract Diseases complications Drainage Humans liver transplantation Liver Transplantation - adverse effects Original outcomes Postoperative Complications T‐tubes |
title | The role of T‐tubes and abdominal drains on short‐term outcomes in liver transplantation – A systematic review of the literature and expert panel recommendations |
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