Destiny for Rendezvous: Is Cholecysto/Choledocholithiasis Better Treated with Dual- or Single-Step Procedures?

Vaccari, Samuele; Minghetti, M; Lauro, Augusto; Bellini, M I; Ussia, Alessandro; Khouzam, Simone; Marino, Ignazio R.; Cervellera, Maurizio; D’Andrea, Vito; Tonini, Valeria

doi:10.1007/s10620-022-07450-7

Cited by 7 publications

(11 citation statements)

References 81 publications

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“…Over the past 30 years, with the introduction of laparoscopic standardized techniques [ 82 ] and improved endoscopic diagnostic and therapeutic procedures, new approaches to combined pathology have emerged [ 83 ]. Current treatment approaches, which vary depending on a center’s experience and availability, include open or laparoscopic CBD exploration, combination laparoscopic cholecystectomy (LC) with endoscopic retrograde cholangiopancreatography (ERCP), and laparo-endoscopic rendezvous (LERV) [ 84 , 85 ]. Therefore, while LC is commonly considered the treatment of choice for gallstones limited to the gallbladder, there is no consensus on the optimal management of combined cholecysto-choledolithiasis.…”

Section: Surgical Treatmentmentioning

confidence: 99%

Acute Cholecystitis from Biliary Lithiasis: Diagnosis, Management and Treatment

et al. 2023

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Biliary lithiasis is a global disorder affecting nearly 20% of the world’s population, although most cases occur without symptoms. Gallbladder stones could move into the common bile duct after gallbladder contraction, causing acute cholecystitis. The progression of the acute disease can take different forms, from mild inflammation, treatable with oral antibiotics, to the most severe forms with septic shock or biliary peritonitis, requiring specific treatment. Liver function tests and abdominal ultrasound are generally sufficient for diagnostic purposes. The most commonly used antibiotic is penicillin, with piperacillin achieving the best results; alternatively, fluoroquinolones could also be used, although there is no univocal consensus and surgery remains the only definitive treatment. A prolonged antibiotic therapy after cholecystectomy seems inadvisable, except in severe cases and/or in the immuno-compromised patient, where it should be periodically evaluated to avoid antibiotic resistance and unnecessary use. This review presents an evidence-based analysis to describe the advantages and disadvantages of the available options for the treatment of biliary lithiasis and cholecystitis, from the pathophysiological mechanisms behind lithiasis formation and also covering the main diagnostic findings for biliary stones, recommending an approach tailored to the patient’s characteristics and to the team’s expertise.

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Section: Surgical Treatmentmentioning

confidence: 99%

Acute Cholecystitis from Biliary Lithiasis: Diagnosis, Management and Treatment

et al. 2023

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“…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 ].…”

Section: Managementmentioning

confidence: 99%

“…Its incidence increases with advancing age. Primary or native stones are relatively rare[ 1 - 5 ]. One-stage or two-stage management continues to be controversial, but both provide equivalent outcomes[ 4 , 6 ].…”

Section: Introductionmentioning

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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“…El tratamiento quirúrgico se establece mediante la clínica del paciente y diversos factores como el costo, edad, la dimensión, localización de los litos, y según el algoritmo de manejo para coledocolitiasis (Figura 4) (Guzmán Calderón et al, 2022;Cianci & Restini, 2021;Prieto-Ortiz et al, 2020;Vaccari et al, 2022).…”

Section: Coledocolitiasisunclassified

Investigación multidisciplinaria desde una visión multidisciplinar. Libro 1

2023

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Destiny for Rendezvous: Is Cholecysto/Choledocholithiasis Better Treated with Dual- or Single-Step Procedures?

Cited by 7 publications

References 81 publications

Acute Cholecystitis from Biliary Lithiasis: Diagnosis, Management and Treatment

Acute Cholecystitis from Biliary Lithiasis: Diagnosis, Management and Treatment

Current management of concomitant cholelithiasis and common bile duct stones

Investigación multidisciplinaria desde una visión multidisciplinar. Libro 1

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