Laparo-endoscopic management of chole-choledocholithiasis: Rendezvous or intraoperative ERCP? A single tertiary care center experience

Abstract

IntroductionThe management of chole-choledocholithiasis remains a matter of debate to preserve minimal invasive management and different options have been proposed, with single- or two-stage approaches. Two techniques of single-stage approach are intraoperative ERCP and laparoscopic rendezvous, which have the great advantage of reducing the length of hospital stay with increased patient compliance. This retrospective study aims to evaluate and compare the efficacy and safety of intraoperative ERCP and rendezvous technique for more than 15 years.Materials and methodsClinical records of 113 patients who underwent single-stage management for chole-choledocholithiasis between January 2003 and December 2020 were retrospectively reviewed using a prospectively maintained database. Patients were separated into two groups: those managed with intraoperative ERCP and those with rendezvous, and their intraoperative and postoperative parameters were compared. All patients were followed up for 6 months in an outpatient setting.ResultsA total of 68 (60%) patients were treated with intraoperative ERCP, while the remaining 45 (40%) were treated with rendezvous. There were no significant differences in terms of comorbidities. ERCP was performed with a median operative time of 145 min (104–168) and an endoscopic time of 27 min (15–36). Meanwhile, rendezvous was performed with a significantly lower operative [120 min (94–147)] and endoscopic time [15 min (12–22)]. No intraoperative complications were recorded. Patients treated with rendezvous had a significantly shorter median hospitality stay [4 (3–5) vs. 3 (2–4) days, p < 0.05]. No hospital readmissions or mortalities were observed in either group after 30 days. Ten mild pancreatitis cases were observed, mainly in the intraoperative ERCP group (9 vs. 1, p < 0.05), and all were treated conservatively. Only two patients treated with intraoperative ERCP developed biliary complications later on.ConclusionLaparoscopic rendezvous should be considered a preferable alternative to intraoperative ERCP for the treatment of patients with concomitant CBD stones and gallstones.

Rendezvous "Laparo-Endoscopic" Management of Cholecysto-Choledocholithiasis: A Comparison Between Two Techniques

“…In current retrospective research from Italy done by Lagouvardou et al, the median stage II time was 15 minutes (range of 12-22 minutes) (8).…”

Current management of concomitant cholelithiasis and common bile duct stones

“…However, the intraoperative rendezvous group had a longer operative time but less postoperative pancreatitis, morbidity and hospitalization[ 30 ]. A recent retrospective study from Italy demonstrated that laparoscopic rendezvous shortened the endoscopic time and may be a reasonable alternative to intraoperative ERCP[ 31 ].…”

Effect of endoscopic sphincterotomy and endoscopic papillary balloon dilation endoscopic retrograde cholangiopancreatographies on the sphincter of Oddi

“…After decades of development, ERCP has many advantages, such as less trauma, less pain, faster recovery, and fewer postoperative complications, and is widely used for diagnosing and treating choledocholithiasis[ 10 ]. The primary and emerging procedures of ERCP include endoscopic sphincterotomy (EST), endoscopic papillary balloon dilation (EPBD), endoscopic sphincterotomy plus balloon dilation (ESBD), and endoscopic endoclip papilloplasty (EEPP)[ 11 ].…”