One-stage approach to cholecystocholedocholithiasis treatment: a feasible surgical strategy for emergency settings and frail patients

Pizzicannella, Margherita; Barberio, Manuel; Lapergola, Alfonso; Gregori, Matteo; Maurichi, Francesco Andrea; Gallina, Stefano; Benedicenti, Pierluigi; Viola, Massimo

doi:10.1007/s00464-022-09537-8

Cited by 2 publications

(3 citation statements)

References 27 publications

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“…Compared to the two stage approach (LC plus ERCP), LERV can be associated to higher efficacy and a better safety profile [23][24][25][26]. In one of the most significant research in literature, Ricci et al reported that the combined LC and intraoperative ERCP approach (LERV) has the greatest odd to be the safest and the most successful choice [22].…”

Section: Discussionmentioning

confidence: 99%

“…Therefore is not unforeseen that scheduling separately the two teams seems easier to manage. Moreover, the shortage of skilled biliary endoscopists and the difficulties or even the lack of cooperation between endoscopic and surgical teams pushes the decision towards the two stage technique [25,42]. In our work, we endeavour to manage and organise the operating rooms and the teamwork in the best way possible to achieve close collaboration and improved outcomes in the long run [43].…”

Section: Discussionmentioning

confidence: 99%

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Laparoendoscopic Rendez-Vous: An Effective and Safe Approach in the Management of Cholecysto-Choledocholithiasis

Percario,

Panaccio,

Caldarella

et al. 2024

Preprint

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Background: The two-stage technique combining the Endoscopic Retrograde CholangioPancreatography (ERCP) with common bile duct (CBD) clearance carried out before the laparoscopic cholecystectomy represents the most common approach for CBD stones. Over time, different techniques have been proposed to manage cholecysto- choledocholithiasis (CCL) advantageously in one stage. Among these, the laparoendoscopic rendez-vous (LERV) addresses the CCL issue with a laparoscopic cholecystectomy with insertion of a guide wire performed at initial stage of the procedure, followed by the clearance of the bile duct carried out by the endoscopists. The goal of this study was to evaluate the efficacy and safeness of LERV procedure recording results and complications, also making a comparison between our results and current literature. Methods: We reviewed our experience of all consecutive patients with cholecysto-choledocholithiasis managed with LERV between January 2018 and December 2023. LERV success rate, operative time, length of hospital stay, stone recurrence, incidence of endoscopic and surgical complications were analysed. Results: A total of 120 patients underwent LERV in our facilities. We reported a 97% LERV success rate, 1.6% conversion-to-open rate, a median intraoperative time of 122 (range 95-220) min. The median hospital stay was 4 (range 2-38) days. An overall morbidity of 15% was reported (18/120): 15 Clavien-Dindo type 1/2, 2 type 3a and one type 3b. In two cases a re-operation during the hospital stay was necessary. At a median follow-up of 14 months (3-59) five patients experienced stone recurrence requiring redo-ERCP in two cases. Conclusion: LERV offers the significant advantage of a single stage procedure and hospitalisation along with a lower risk of post-ERCP pancreatitis, failed CBD cannulation and complications. Our experience confirms safety and effectiveness of the technique for CCL management.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Laparoendoscopic Rendez-Vous: An Effective and Safe Approach in the Management of Cholecysto-Choledocholithiasis

Percario,

Panaccio,

Caldarella

et al. 2024

Preprint

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show abstract

“…Rendezvous technique: This technique is a well-established method for the management of CBD stones that combines ERCP-ES stone clearance and LC in the same operation with the patient under general anesthesia[ 1 , 6 , 25 ]. It is feasible, safe and effective not only in elective but also in emergency cases, as shown in a recent study including 61 cases and 120 cases, respectively[ 26 ]. In addition, the method has applications in pediatric patients with excellent results[ 27 ].…”

Section: Managementmentioning

confidence: 99%

Current management of concomitant cholelithiasis and common bile duct stones

Pavlidis¹,

Pavlidis²

2023

World J Gastrointest Surg

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The management policy of concomitant cholelithiasis and choledocholithiasis is based on a one- or two-stage procedure. It basically includes either laparoscopic cholecystectomy (LC) with laparoscopic common bile duct (CBD) exploration (LCBDE) in the same operation or LC with preoperative, postoperative and even intraoperative endoscopic retrograde cholangiopancreatography-endoscopic sphincterotomy (ERCP-ES) for stone clearance. The most frequently used worldwide option is preoperative ERCP-ES and stone removal followed by LC, preferably on the next day. In cases where preoperative ERCP-ES is not feasible, the proposed alternative of intraoperative rendezvous ERCP-ES simultaneously with LC has been advocated. The intraoperative extraction of CBD stones is superior to postoperative rendezvous ERCP-ES. However, there is no consensus on the superiority of laparoendoscopic rendezvous. This is equivalent to a traditional two-stage procedure. Endoscopic papillary large balloon dilation reduces recurrence. LCBDE and intraoperative ERCP have similar good outcomes. The risk of recurrence after ERCP-ES is greater than that after LCBDE. Laparoscopic ultrasonography may delineate the anatomy and detect CBD stones. The majority of surgeons prefer the transcductal instead of the transcystic approach for CBDE with or without T-tube drainage, but the transcystic approach must be used where possible. LCBDE is a safe and effective choice when performed by an experienced surgeon. However, the requirement of specific equipment and advanced training are drawbacks. The percutaneous approach is an alternative when ERCP fails. Surgical or endoscopic reintervention for retained stones may be needed. For asymptomatic CBD stones, ERCP clearance is the first-choice method. Both one-stage and two-stage management are acceptable and can ensure improved quality of life.

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One-stage approach to cholecystocholedocholithiasis treatment: a feasible surgical strategy for emergency settings and frail patients

Cited by 2 publications

References 27 publications

Laparoendoscopic Rendez-Vous: An Effective and Safe Approach in the Management of Cholecysto-Choledocholithiasis

Laparoendoscopic Rendez-Vous: An Effective and Safe Approach in the Management of Cholecysto-Choledocholithiasis

Current management of concomitant cholelithiasis and common bile duct stones

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