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 I 2 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; I 2 = 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; I 2 = 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.
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References
Menezes N, Marson LP, Debeaux AC, Muir IM, Auld CD (2000) Prospective analysis of a scoring system to predict choledocholithiasis. Br J Surg 87:1176–1181
Videhult P, Sandblom G, Rasmussen IC (2009) How reliable is intraoperative cholangiography as a method for detecting common bile duct stones? A prospective population-based study on 1,171 patients. Surg Endosc 23:304–312
Borzellino G, Rodella L, Saladino E, Catalano F, Politi L, Minicozzi A, Cordiano C (2010) Treatment for retrieved common bile duct stones during laparoscopic cholecystectomy: the rendezvous technique. Arch Surg 145:1145–1149
Collins C, Maguire D, Ireland A, Fitzgerald E, O’Sullivan GC (2004) A prospective study of common bile duct calculi in patients undergoing laparoscopic cholecystectomy: natural history of choledocholithiasis revisited. Ann Surg 239:28–33
Martin DJ, Vernon DR, Toouli J (2006) Surgical versus endoscopic treatment of bile duct stones. Cochrane Database Syst Rev (2):CD003327
La Greca G, Barbagallo F, Sofia M, Latteri S, Russello D (2010) Simultaneous laparoendoscopic rendezvous for the treatment of cholecystocholedocholithiasis. Surg Endosc 24:769–780
Cavina E, Franceschi M, Sidoti F, Goletti O, Buccianti P, Chiarugi M (1998) Laparoendoscopic “rendezvous”: a new technique in the choledocholithiasis treatment. Hepatogastroenterology 45:1430–1435
Gluud C, Nikolova D, Klingenberg SL, Alexakis N, Als-Nielsen B, Colli A (2012) Cochrane Hepatobiliary Group. About The Cochrane Collaboration (Cochrane Review Groups (CRGs), Issue 2. Art. no.: LIVER
Royle P, Milne R (2003) Literature searching for randomized controlled trials used in Cochrane reviews: rapid versus exhaustive searches. Int J Technol Assess Health Care 19:591–603
Higgins JPT, Green S (eds) (2011) Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Copenhagen, Denmark
DerSimonian R, Laird N (1986) Metaanalysis in clinical trials. Control Clin Trials 7:177–188
Review Manager (RevMan) (2011) [Computer program], Version 5.1. The Nordic Cochrane Centre, The Cochrane Collaboration, 2011. Copenhagen, Denmark
Morino M, Baracchi F, Miglietta C, Furlan N, Ragona R, Garbarini A (2006) Preoperative endoscopic sphincterotomy versus laparoendoscopic rendezvous in patients with gallbladder and bile duct stones. Ann Surg 244:889–893; discussion 893–896
Tsovaras G, Baloyiannis I, Zachari E, Symeonidis D, Zacharoulis D, Kapsoritakis A, Paroutoglou G, Potamianos S (2012) Laparoendoscopic rendezvous versus preoperative ERCP and laparoscopic cholecystectomy for the management of cholecysto-choledocholithiasis: interim analysis of a controlled randomized trial. Ann Surg 255:435–439
Lella F, Bagnolo F, Rebuffat C, Scalambra M, Bonassi U, Colombo E (2006) Use of the laparoscopic-endoscopic approach, the so-called “rendezvous” technique, in cholecystocholedocholithiasis: a valid method in cases with patient-related risk factors for post-ERCP pancreatitis. Surg Endosc 20:419–423
Rábago LR, Vicente C, Soler F, Delgado M, Moral I, Guerra I, Castro JL, Quintanilla E, Romeo J, Llorente R, Vázquez Echarri J, Martínez-Veiga JL, Gea F (2006) Two-stage treatment with preoperative endoscopic retrograde cholangiopancreatography (ERCP) compared with single-stage treatment with intraoperative ERCP for patients with symptomatic cholelithiasis with possible choledocholithiasis. Endoscopy 38:779–786
La Greca G, Barbagallo F, Di Blasi M, Chisari A, Lombardo R, Bonaccorso R, Latteri S, Di Stefano A, Russello D (2008) Laparoendoscopic “rendezvous” to treat cholecystocholedocolithiasis: effective, safe and simplifies the endoscopist’s work. World J Gastroenterol 14:2844–2850
Saccomani G, Durante V, Magnolia MR, Ghezzo L, Lombezzi R, Esercizio L, Stella M, Arezzo A (2005) Combined endoscopic treatment for cholelithiasis associated with choledocholithiasis. Surg Endosc 19:910–914
Williams GL, Vellacott KD (2002) Selective operative cholangiography and Perioperative endoscopic retrograde cholangiopancreatography (ERCP) during laparoscopic cholecystectomy: a viable option for choledocholithiasis. Surg Endosc 16:465–467
Acknowledgments
We thank Dimitrinka Nikolova (Cochrane Hepato-biliary Group) for continuous support.
Disclosures
Alberto Arezzo, Nereo Vettoretto, Federico Famiglietti, Lorenzo Moja, and Lorenzo Moja have no conflicts of interest or financial ties to disclose.
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Arezzo, A., Vettoretto, N., Famiglietti, F. et al. Laparoendoscopic rendezvous reduces perioperative morbidity and risk of pancreatitis. Surg Endosc 27, 1055–1060 (2013). https://doi.org/10.1007/s00464-012-2562-3
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DOI: https://doi.org/10.1007/s00464-012-2562-3