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

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Abstract

Background

The purpose of the study was to compare the safety and effectiveness of laparoscopic common bile duct exploration plus laparoscopic cholecystectomy (LCBDE+LC) with preoperative endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy (pre-ERCP+LC) for cholecystocholedocholithiasis.

Methods

An electronic search was performed using the following databases: PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov until 1 July 2018. Randomized controlled trials (RCTs) comparing LCBDE+LC versus pre-ERCP+LC were included. The common bile duct (CBD) stone clearance rate, postoperative bile leakage, postoperative pancreatitis, morbidity, mortality, and overall hospital stay were analyzed.

Results

Twelve RCTs involving 1545 patients were included in this meta-analysis. Of the 12 RCTs, seven confirmed and five did not confirm CBD stones preoperatively. The meta-analysis showed a significantly higher CBD stone clearance rate for pre-ERCP+LC than LCBDE+LC. A similar result was found in the subgroup analysis of patients with confirmed CBD stones. A significantly lower postoperative bile leakage rate was found for pre-ERCP+LC than LCBDE+LC in all 12 RCTs and in the subgroup of patients with confirmed CBD stones. However, a significantly higher rate of pancreatitis was found in pre-ERCP+LC and in the subgroup of patients with confirmed CBD stones. LCBDE+LC was superior to pre-ERCP+LC in terms of the overall hospital stay. No significant differences were found in morbidity or mortality.

Conclusions

Pre-ERCP+LC is associated with a higher CBD stone clearance rate, lower postoperative bile leakage rate, and higher rate of pancreatitis. LCBDE+LC might help to shorten the hospital stay. Further studies on this topic are recommended.

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Data Availability

All the data used in the study can be obtained from the original articles.

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The author(s) received no financial support for the research, authorship, and/or publication of this article.

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Authors and Affiliations

  1. Department of Hepatobiliary Surgery, Dongyang People’s Hospital, Dongyang, 322100, Zhejiang, China

    Yunxiao Lyu, Yunxiao Cheng, Bin Cheng & Xin Jin

  2. Department of Personnel Office, Dongyang People’s Hospital, Dongyang, 322100, Zhejiang, China

    Ting Li

  3. Department of General Surgery, Dongyang People’s Hospital, 60 West Wuning Road, Dongyang, 322100, Zhejiang, China

    Yunxiao Lyu

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Correspondence to Yunxiao Lyu.

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Yunxiao Lyu, Yunxiao Cheng, Ting Li, Bin Cheng, and in Jin have no conflicts of interest or financial ties to disclose.

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Lyu, Y., Cheng, Y., Li, T. et al. Laparoscopic common bile duct exploration plus cholecystectomy versus endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy for cholecystocholedocholithiasis: a meta-analysis. Surg Endosc 33, 3275–3286 (2019). https://doi.org/10.1007/s00464-018-06613-w

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