Laparoscopic common bile duct exploration plus cholecystectomy versus endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy for cholecystocholedocholithiasis: a meta-analysis

Lyu, Yunxiao; Cheng, Yunxiao; Li, Ting; Cheng, Bin; Jin, Xin

doi:10.1007/s00464-018-06613-w

Cited by 99 publications

(89 citation statements)

References 37 publications

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“…23; p=0.34). This is in contrast to other studies which denoted shorter hospital stay in this Group A than Group B [18,32,39] .…”

Section: Group B P-valuecontrasting

confidence: 99%

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Comparative Study between Laparoscopic Common Bile Duct Exploration and Endoscopic Retrograde Cholangiopancreatography Plus Laparoscopic Cholecystectomy for Choledocholithiasis

Rady¹,

Esmat

2019

The Medical Journal of Cairo University

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Background: Overall, 5% to 15% of patients undergoing cholecystectomy for cholelithiasis have concomitant bile duct stones, and the incidence of choledocholithiasis increases with age. Endoscopic Retrograde Cholangiopancreatography (ERCP) with consequent Laparoscopic Cholecystectomy (LC) has been the favored approach for the treatment of choledocholithiasis for quite a long time; however in the course of recent years, Laparoscopic Common Bile Duct Exploration (LCBDE) has been offered to patients with suspected choledocholithiasis. Aim of Study: The aim of this work is to compare the efficacy, safety, and the surgical outcomes of LCBDE with ERCP followed by laparoscopic cholecystectomy and determine the most appropriate approach for patients with choledocholithiasis. Patients and Methods: A prospective randomized clinical study was carried out from March 2017 to September 2018. It included 50 patients with cholecysto-choledocholithiasis who were divided into two groups: Group A (25 patients) included patients who underwent laparoscopic transcystic common bile duct exploration and stone extraction with LC in one stage, and Group B (25 patients) included patients who underwent endoscopic retrograde cholangiopancreatography for CBD stone extraction followed by LC in two stages. The Common Bile Duct (CBD) stone clearance rate, post-operative bile leakage, post-operative morbidity, mortality, overall hospital stay, and patient satisfaction were analyzed. Results: LCBDE and ERCP+LC were similar in terms of clearance rate, operative time postoperative complications, retained CBD stones, and postoperative length of stay, but there was a significant difference in number of procedures and patient satisfaction. Conclusion: Although both approaches have equivalent success rates, LCBDE is better in terms of fewer procedures, and better satisfaction compared with ERCP + LC. Our study suggests that one-stage management is the treatment of choice for patients with cholecystocholedocholithiasis.

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“…23; p=0.34). This is in contrast to other studies which denoted shorter hospital stay in this Group A than Group B [18,32,39] .…”

Section: Group B P-valuecontrasting

confidence: 99%

“…This is still controversial. More detailed and higher-quality research on postoperative pancreatitis and bile leakage is necessary in the future [32] .…”

Section: Group B P-valuementioning

confidence: 99%

Comparative Study between Laparoscopic Common Bile Duct Exploration and Endoscopic Retrograde Cholangiopancreatography Plus Laparoscopic Cholecystectomy for Choledocholithiasis

Rady¹,

Esmat

2019

The Medical Journal of Cairo University

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“…More detailed and higher-quality research on postoperative pancreatitis and bile leakage is necessary in the future. 32 In our study ERCP was successful for 21 of 25patients (84.0%). More than one attempt for complete clearance of the CBD was required for 3 patients (12%).…”

Section: Discussionsupporting

confidence: 53%

Comparative study between laparoscopic common bile duct exploration and endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy for choledocholithiasis

et al. 2019

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Background: Endoscopic retrograde cholangiopancreatography (ERCP) with consequent laparoscopic cholecystectomy (LC) has been the favored approach for the treatment of choledocholithiasis for a long time; however recently, laparoscopic common bile duct exploration (LCBDE) has been offered to patients with suspected choledocholithiasis. Objective and aim of this work was to compare the efficacy, safety, and the surgical outcomes of LCBDE with ERCP followed by LC and determine the most appropriate approach for patients with choledocholithiasis.Methods: A prospective clinical study was carried out from March 2017 to September 2018. It included 50 patients with cholecysto-choledocholithiasis who were divided into two groups: group A (25 patients) included patients who underwent transcystic LCBDE and stone extraction with LC in one stage, and group B (25 patients) included patients who underwent ERCP followed by LC in two stages. The common bile duct (CBD) stone clearance rate, postoperative bile leakage, postoperative morbidity, mortality, overall hospital stay, and patient satisfaction were analyzed.Results: LCBDE and ERCP+LC were similar in terms of clearance rate, operative time, postoperative complications, retained CBD stones, and postoperative length of stay, but there was a significant difference in number of procedures and patient satisfaction.Conclusions: Although both approaches have equivalent success rates, LCBDE is better in terms of fewer procedures, and better satisfaction compared with ERCP + LC. Our study suggests that one-stage management is the treatment of choice for patients with cholecysto-choledocholithiasis.

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“…With improvements in endoscopy, ERCP is becoming more popular than open CBD exploration in the management of CBD stones because it is less invasive and offers better safety. However, open CBD exploration still has its own advantages in patients with both CBD and gallbladder stones . Hybrid operations such as LC + LCBDE and LC + ERCP/endoscopic sphincterotomy provide optimized outcomes in treating patients with gallbladder stones and choledocholithiasis .…”

Section: Discussionmentioning

confidence: 89%

“…However, open CBD exploration still has its own advantages in patients with both CBD and gallbladder stones. 10,11 Hybrid operations such as LC + LCBDE and LC + ERCP/endoscopic sphincterotomy provide optimized outcomes in treating patients with gallbladder stones and choledocholithiasis. 12,13 However, the question of superiority remains controversial.…”

Section: Discussionmentioning

confidence: 99%

Implementation of a simplified self‐releasing biliary stent in choledocholithiasis: Experience in 150 cases

Yang

Zhang

et al. 2019

Asian J Endoscop Surgery

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Introduction Our aim was to introduce a simple way of making a self‐releasing biliary stent for laparoscopic common biliary duct exploration. Methods To make a self‐releasing biliary stent, an absorbable thread was sutured to a J‐shape polyurethane biliary stent. After the evacuation of the calculi, a guide wire was placed into the duodenum antegradely, facilitating the insertion of the biliary stent. The pigtail of the stent was left in the duodenum. The choledochotomy was then sutured, with the absorbable thread left outside the bile duct. Results This study consisted of 150 patients with choledocholithiasis. The mean operating time was 126 ± 36 minutes. The postoperative hospital stay was 6.5 ± 3.6 days. In 149 cases, the biliary stents were released and discharged out of the body with feces. The inside body time of the rapid‐releasing stent was 13.6 ± 2.6 days, and it was 28.0 ± 4.6 days for the slow‐releasing stent. One stent was removed by endoscopy. Transient hyperamylasemia occurred in 32 patients (21.3%) without clinical onset of pancreatitis. Bile leakage occurred in three patients (2.0%), all of whom recovered after treatment. Residual lithiasis was found in one patient (0.7%) and was retracted by endoscopy 30 days after the first procedure. No infection or dislocation of the stent was found. Conclusion For laparoscopic common biliary duct exploration for choledocholithiasis, this method provides an alternative way to make a simple and safe self‐releasing stent. It enables the endoscopic retraction of biliary stents to be avoided.

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Laparoscopic common bile duct exploration plus cholecystectomy versus endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy for cholecystocholedocholithiasis: a meta-analysis

Cited by 99 publications

References 37 publications

Comparative Study between Laparoscopic Common Bile Duct Exploration and Endoscopic Retrograde Cholangiopancreatography Plus Laparoscopic Cholecystectomy for Choledocholithiasis

Comparative Study between Laparoscopic Common Bile Duct Exploration and Endoscopic Retrograde Cholangiopancreatography Plus Laparoscopic Cholecystectomy for Choledocholithiasis

Comparative study between laparoscopic common bile duct exploration and endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy for choledocholithiasis

Implementation of a simplified self‐releasing biliary stent in choledocholithiasis: Experience in 150 cases

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