Meta‐analysis of laparoscopic transcysticversustranscholedochal common bile duct exploration for choledocholithiasis

Abstract

Background It is not clear whether laparoscopic transcystic exploration (LTCE) laparoscopic choledochotomy (LCD) is superior in the management of choledocholithiasis. In this meta‐analysis, the success of LTCE versus LCD was evaluated. Methods Cochrane Central Register of Controlled Trials, Web of Science, Trip, PubMed, Ovid and Embase databases were searched systematically for relevant literature up to May 2017. Studies that compared the success rate of LTCE and LCD in patients with choledocholithiasis were included. PRISMA guidelines were followed. Multiple independent reviewers contributed on a cloud‐based platform. Random‐effects model was used to calculate odds ratios (ORs) or standardized mean differences (MDs) with 95 per cent confidence intervals. An a priori hypothesis was generated based on clinical experience that LTCE is as successful as LCD. Results Of 3533 screened articles, 25 studies comprising 4224 patients were included. LTCE achieved a lower duct clearance rate than LCD (OR 0.38, 95 per cent c.i. 0·24 to 0·59). It was associated with a shorter duration of surgery (MD −0·86, 95 per cent c.i. −0·97 to −0·77), lower bile leak (OR 0·46, 0·23 to 0·93) and shorter hospital stay (MD −0·78, −1·14 to −0·42) than LCD. There was no statistically significant difference in conversion, stricture formation or reintervention rate. Conclusion LCD has a higher rate of successful duct clearance, but is associated with a longer duration of surgery and hospital stay, and a higher bile leak rate.

Laparoscopic Management of Common Bile Duct Stones using Semi-rigid Ureteroscope- a Single Centre Prospective Observational Study

“…The sphincter of Oddi (SOD) prevents reflux of duodenal contents into the bile duct. Compared to the laparoscopic approach which keeps the SOD intact, the endoscopic approach in managing CBD stones requires sphincterotomy or balloon sphincteroplasty and it enhances the rate of bactibilia due to duodenobiliary reflux [18]. In our study, the reasons for failure of the endoscopic approach to clear the CBD are due to distal CBD stricture, deformed duodenum, impacted stones, and periampullary diverticulum.…”

Multi‐institutional expert update on the use of laparoscopic bile duct exploration in the management of choledocholithiasis: Lesson learned from 3950 procedures

“…However, the sensitivity of this test is lower for small stones (<6 mm) and biliary sludge. 13 The best approach to the bile duct during LCBE will be determined by the characteristics of the patient, the equipment available and obviously the experience of the surgeon. The two main approaches to the common bile duct are the transcystic and the choledochotomy.…”

Titanium clip migration after cholecystectomy: original technique for laparoscopic transcystic extraction when endoscopic retrograde cholangiopancreatography fails

“…In the present case, we propose an innovative laparoscopic approach including transcystic extraction with endoscopic hose-type biopsy forceps. Although the transcystic approach has many advantages and a success rate of about 87% among patients with choledocholithiasis [ 13 ], the limiting factors include anatomic features related to the cystic duct that hinder its cannulation and stone extraction, such as small size, tortuous duct, obstructive cystic valve, rupture of cystic duct during instrumentation in case of friable tissues and low level of insertion of cystic duct [ 14 ].…”