Efficacy and safety of laparoscopic bile duct exploration versus endoscopic sphincterotomy for concomitant gallstones and common bile duct stones

Abstract

Background:The purpose of this study was to compare the efficacy and safety of laparoscopic cholecystectomy (LC) plus laparoscopic common bile duct (CBD) stones exploration (LCBDE) with LC plus endoscopic sphincterotomy (EST) in the treatment of patients with gallstones and CBD stones.Methods:The authors searched PubMed, Web of Science, and Embase to identify relevant studies. Risk ratios (RRs) were pooled to compare stone clear, retained stone, conversion to other procedures, and complications. Weighted mean differences (WMDs) were pooled to compare operative time, and length of hospital stay. A fixed-effects model or random-effects model was used to pool the estimates, according to the heterogeneity among the included studies.Results:A total of 11 randomized controlled trials (RCTs) involving 1663 patients were included in this meta-analysis. The pooled estimate suggested that LC-LCBDE had comparable effects with LC-EST in terms of CBD stone clear rate (RR = 1.02, 95% CI: 0.95, 1.09; P = .583), retained stones rate (RR = 1.27, 95% CI: 0.51, 3.19; P = .607), and length of hospital stay (WMD = −0.96 days, 95% CI: −2.20, 0.28). In addition, LC-LCBDE was associated with significantly higher conversion rate (RR = 1.59, 95% CI: 1.08, 2.35; P = .019) and less operative time (WMD = −11.55 minutes, 95% CI: −16.68, −6.42; P < .001) than LC-EST. The incidence of complications was not significant difference between the 2 surgical approaches (RR = 1.07, 95% CI: 0.86, 1.34; P = .550).Conclusion:Based on the current evidence, both LC-LCBDE and LC-EST were highly effective in detecting and removing CBD stones and were equivalent in complications. However, our results might be biased by the limitations. Large-scale well-designed RCTs are needed to confirm our findings.

Laparoscopic common bile duct exploration in patients with previous abdominal biliary tract operations

“…The short postoperative hospital stay in the LCBDE group might be attributed to the small incision and early time to oral intake due to the early recovery of bowel function. Fourth, a recent meta-analysis showed that the operative time was 119.5 min and the conversion rate was 9% in LCBDE, which were lower than the 170 (60-480) min and 17%, respectively, obtained in our study [18]. All the procedures (including laparotomy and laparoscopic surgery) were performed by an experienced surgeon.…”

“…At the same time, the treatment for CBD stones has changed, and an increasing number of options are now prevalent. These new options include ERCP, endoscopic papillary balloon dilation (EPBD), or EST (if necessary) followed by LC; LC and intraoperative transcystic or direct CBD exploration; postoperative ERCP with EPBD/EST and stone extraction; intraoperative ERCP, EPBD/EST, and stone extraction during LC; and conversion to laparotomy [18,19]. Therefore, there are two main surgical strategies in clinical practice: a single-stage surgical strategy involving LCBDE and stone retrieval at the time of LC and an alternative option of staged procedures, with LC and ERCP on separate dates for CBD stone clearance [20].…”

Single-stage approach for the management of choledocolithiasis with concomitant cholelithiasis. Implementation of a protocol in a secondary hospital

“…Certainly ERCP is irreplaceable in the setting of severe acute cholangitis, progressive jaundice or severe pancreatitis. 1,2,5,7,13,28 Therefore ERCP skills and close relationships with gastroenterologists must be encouraged. Pointing to the future, the advantages of single-stage management for patients with concomitant gallstones and CBDS should be considered when planning surgical training.…”

“…Conversely, the rate of retained stones in our experience, was slightly lower than published by other groups. 2,13,28 However, 3 mm choledochoscope for transcystic instrumentation and laser lithotripsy availability would likely decrease our rate of retained stones and conversions rate.…”

Evaluación de costo efectividad del tratamiento en un solo tiempo de colelitiasis con coledocolitiasis mediante el uso exclusivo de laparoscopia y su asociación con el abordaje endoscópico

“…En el estudio publicado por la ASGE 2019, respecto a la eficacia y seguridad de la ELVB en comparación con la esfinterotomía endoscópica, reporta no existir diferencias significativas entre los procedimientos quirúrgicos y endoscópicos respecto a complicaciones, pero fuga biliar es algo mas frecuente en ELVB (RR 2,66 con IC 95% P=013) (BUXBAUM et al, 2019;GAO et al, 2017).…”