Surgical Endoscopy

, Volume 27, Issue 4, pp 1055–1060

Laparoendoscopic rendezvous reduces perioperative morbidity and risk of pancreatitis

  • Alberto Arezzo
  • Nereo Vettoretto
  • Federico Famiglietti
  • Lorenzo Moja
  • Mario Morino
Review

DOI: 10.1007/s00464-012-2562-3

Cite this article as:
Arezzo, A., Vettoretto, N., Famiglietti, F. et al. Surg Endosc (2013) 27: 1055. doi:10.1007/s00464-012-2562-3

Abstract

Background

The ideal management of cholelithiasis and common bile duct stones still is controversial. Although the two-stage sequential approach remains the prevalent management, several trials have concluded that the so-called laparoendoscopic rendezvous (LERV) technique offers some advantages, such as a reduced risk of post-ERCP (endoscopic retrograde cholangiopancreatography) pancreatitis. This study aimed to compare the single-stage LERV technique with the two-stage endoscopic sphincterotomy followed by laparoscopic cholecystectomy.

Methods

A search for randomized controlled trials (RCTs) comparing LERV and the two-stage sequential approach was conducted. The outcomes considered were overall complications and pancreatitis. Medline, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from 1998 to July 2012. Odds ratios (ORs) were extracted and pooled using a fixed or random-effect model depending on I2 used as a heterogeneity measure.

Results

Four RCTs, including a total of 430 patients, met the inclusion criteria. The incidence of overall complications was lower in the LERV group (11.2 %) than in the two-stage intervention group (18.1 %) (OR, 0.56; 95 % confidence interval [CI], 0.32–0.99; P = 0.04; I2 = 45 %). The findings showed that LERV was associated with less clinical pancreatitis (2.4 %) than the two-stage technique (8.4 %) (OR, 0.33; 95 % CI, 0.12–0.91; P = 0.03; I2 = 33 %).

Conclusions

Despite the limitation of a small number of studies completed, the evidence of RCTs shows that LERV is superior to two-stage treatment due to a reduction in overall complications, particularly pancreatitis.

Keywords

Common bile duct Gallbladder Laparoendoscopic rendezvous Metaanalysis Stones Systematic review 

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Alberto Arezzo
    • 1
  • Nereo Vettoretto
    • 2
  • Federico Famiglietti
    • 1
  • Lorenzo Moja
    • 3
  • Mario Morino
    • 1
  1. 1.Digestive, Colorectal, Oncologic, and Minimal Invasive SurgeryUniversity of TurinTurinItaly
  2. 2.Laparoscopic Surgical Unit, M. Mellini HospitalChiariItaly
  3. 3.Department of Biomedical Sciences for HealthUniversity of MilanMilanItaly

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