Meta-analysis of single-stage versus two-staged management for concomitant gallstones and common bile duct stones

Abstract

Objective: The purpose of this article was to compare the effectiveness and safety of single-stage (laparoscopic cholecystectomy [LC] plus laparoscopic common bile duct exploration [LCBDE]) with two-stage (LC plus endoscopic retrograde cholangiopancreatography (ERCP)/endoscopic sphincterotomy [EST]) in management for concomitant gallstones and common bile duct (CBD) stones. Materials and Methods: Systematic review and meta-analysis of randomised controlled trials (RCTs) comparing outcomes following single-stage with two-stage management for concomitant gallstones and CBD stones published from 1990 to 2017 in PubMed, Embase and the Science Citation Index. The primary outcomes were stone clearance from the CBD, post-operative morbidity and mortality. The secondary outcomes were retained stone, conversion to other procedures, length of hospital stay and total operating time. Pooled risk ratio (RR) or weighted mean differences (WMD) with 95% confidence intervals (95% CIs) were calculated using either the fixed effects model or random effects model. Results: Eleven RCTs studies were included in this analysis. These studies included a total of 1338 patients: 666 underwent LC + LCBDE and 672 underwent LC + ERCP/EST. The meta-analysis showed that no significant difference was noted between the two groups regarding CBD stone clearance (RR: 1.06; 95% CI: 0.99–1.14; P = 0.12), post-operative morbidity (RR: 1.03; 95% CI: 0.79–1.34; P = 0.81), mortality (RR: 0.30; 95% CI: 0.06–1.41; P = 0.13), retained stone (RR: 0.91; 95% CI: 0.57–1.47; P = 0.71), conversion to other procedures (RR: 0.80; 95% CI: 0.55–0.16; P = 0.23), length of hospital stay (WMD: 1.24, 95% CI: 3.57–1.09, P = 0.30), total operating time (WMD: 25.42, 95% CI: 22.38–73.22, P = 0.30). Conclusion: Single-stage is efficient and safe in the treatment of patients with concomitant gallstones and CBD stones while avoiding the second procedure. In selected patients, single-stage management for concomitant gallstones and CBD stones might be considered as the preferred approach. However, the findings have to be carefully interpreted due to the existence of heterogeneity, in addition, patient's condition, operator's experience also should be taken into account in making treatment decisions.

Effects of the timing of laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatography on liver, bile, and inflammatory indices and cholecysto-choledocholithiasis patient prognoses

“…Thus, this study suggests that LC 1-3 d after ERCP is the most appropriate therapeutic strategy. However, some studies (24) believe that LC at the early or delayed stage of ERCP has no advantages in terms of stone clearance rate and complications, which may be caused by factors such as differences in included cases and the nature of the disease. Considering that there are many complications associated with ERCP, and serious complications can cause great harm to patients, and can even cause death, the application of ERCP should be avoided clinically, and non-invasive or minimally invasive methods should be adopted instead.…”

Recurrent Cholangitis due to Hem-o-lok Clip Migration after Laparoscopic Common Bile Duct Exploration Treated with Endoscopic Retrograde Cholangiopancreatography

“…6 ERCP for stone extraction is the commonly preferred modality of treatment for CBD stone. 4 Recently, according to the study by Li et al 7 , single-stage surgical strategy such as LC with LCBDE is efficient and safe for the treatment of patients with concomitant CBD stone and gallbladder stone, while avoiding the second procedure. In selected patients, single-stage management for concomitant gallbladder and CBD stones might be considered as the preferred approach.…”

“…In selected patients, single-stage management for concomitant gallbladder and CBD stones might be considered as the preferred approach. 7 Complications associated with LC have been reported in less than five in 1,000. 8 They can be categorized into early and late.…”

Puncture and discission with a needle: A new method for laparoscopic common bile duct exploration

“…Over the past 20 years, LCBDE has undergone a brisk process of maturation, progression, and innovation, [ 10 ] becoming the gold standard technique for cholecystocholedocholithiasis, [ 6 , 11 – 13 ] although a few key problems are yet to be resolved. Direct discission using a retractable scalpel or an electric hook is the most popular current approach; however, this method involves a high risk of CBD injury, bile leakage after primary choledochorrhaphy, scar contracture–induced CBD strictures, and necrosis of the incision margin.…”