Laparo-endoscopic “Rendezvous” to treat cholecysto-choledocolithiasis: Effective, safe and simplifies the endoscopist’s work

Abstract

AIM:To investigate our clinical experience with combined laparo-endoscopic Rendezvous (RV) for the treatment of patients affected by gallstones and common bile duct (CBD) stones and especially to study the never evaluated opinion of the endoscopist concerning the difficulty of the intraoperative endoscopic procedure during the RV in comparison with standard endoscopic retrograde cholangio-pancreatography (ERCP). METHODS:Eighty consecutive patients affected by cholecystolithiasis and diagnosed or suspected CBD stones were treated with a standardized "tailored" RV. The relevant technical features, the feasibility, the effectiveness in stone clearance, the safety but also the simple evaluation of difficulty and agreement of the endoscopist were analyzed with a questionnaire. R E S U LT S :T h e f e a s i b i l i t y w a s 9 7. 5 % a n d t h e effectiveness 100% concerning CBD clearance and solution of coexisting problems at the papilla. Minor morbidity was 3.3%, the operating time was prolonged by a mean of 14 min, the mean hospital stay was 3.8 d and only one stone's recurrence occurred. The endoscopist evaluated the procedure to be simpler than standard ERCP-ES in 81.2% of the cases. C O N C L U S I O N :S i m u l t a n e o u s R V c a r r i e s h i g h effectiveness and safety at least comparable to those reported for other options. The endoscopist is very often satisfied with this approach because of the minimization of some steps of the endoscopic procedure and avoidance of relevant iatrogenic risk factors. If the mandatory collaboration between surgeons and endoscopists is guaranteed, this approach can often be preferable for the patient, the surgeon, the endoscopist and the hospital.

Modern approach to cholecysto-choledocholithiasis

“…The technique was first described almost 20 years ago [52][53][54] , and hypothetically, it combines many advantages, such as minimal invasiveness and an acceptable learning curve, at the price of some organization troubles between endoscopists, surgeons and operating room personnel [55][56][57] , but is yet to be accepted. A robust review by La Greca et al [58] analyzed data from 27 papers, which included almost 800 patients and compared the RVT to other approaches. This research showed an overall bile duct clearance of 92.3% and few complications (1.6%-6% bleeding from the sphincterotomy and 1.7%-7% pancreatitis).…”

Single-stage treatment with intraoperative ERCP: management of patients with possible choledocholithiasis and gallbladder in situ in a non-tertiary Spanish hospital

“…The use of the rendezvous technique prevents Wirsung opacification using contrast agents, damage and manipulation of the papilla and the use of risky techniques to access the papilla, such as precut sphincterotomies [38]. Trying to resolving biliary lithiasis and choledocholithiasis at the same time prevents post-ERCP acute cholecystitis from appearing when the cholecystectomy is delayed [13].…”

“…Use of intraoperative ERCP has slowly increased among the various endoscopy groups, as it combines ease of use in daily clinical practice with a short learning curve, without the high technical requirements for laparoscopic management of the bile duct [13,[36][37][38][39].…”

Dystopic retrohepatic gallbladder and cholecysto‐choledocho lithiasis: the rendez‐vous and indocyanine green fluorescence

“…The gold standard treatment for cholecystolithiasis is laparoscopic cholecystectomy, whereas the gold standard treatment for isolated common bile duct stones is endoscopic clearance 1. The management of patients affected by gallstones complicated by common bile duct (CBD) stones and/or problems at the papilla of Vater is anyway a challenge as there are many available options for treatment, all being effective but which is the best practice is still unknown 2. The gallbladder may have abnormal position, be intrahepatic, have anomalous form, or be duplicated 3.…”