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One-stage laproendoscopic procedure versus two-stage procedure in the management for gallstone disease and biliary duct calculi: a systemic review and meta-analysis

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Abstract

Background

Laparoscopic common bile duct exploration and endoscopic retrograde cholangiopancreatography (ERCP) are secure and effective techniques that recently been used to treat bile duct stones. The purpose of this research was to assess the intra-procedural efficacy and postprocedural upshots of the laparoscopic common bile duct exploration plus laparoscopic cholecystectomy (LCBDE) and ERCP plus laparoscopic cholecystectomy (ERCP + LC).

Methods

All studies contrasting one-stage (LCBDE) with two-stage (ERCP/EST + LC) managements in patients with concomitant gallstones and common bile duct (CBD) stones were included. The primary outcomes were CBD stone clearance, postoperative morbidity, and mortality, while secondary outcomes were conversion with other techniques, duration of stay in hospital, number of procedures used per patient, and operating time. Data were pooled by meta-analysis.

Results

Fourteen studies with 1600 participants were identified. Each arm contains 800 participants. There is no significant difference between the two arms regarding successful CBD stone clearance (RR = 0.96, P = 0.15), mortality (RR = 1.74, P = 0.33), morbidity (RR = 0.89, P = 0.32), conversion to additional procedure (RR = 1.44, P = 0.09), operating time (MD = −1.43 min, P = 0.95), hospital stay (MD = 1.31 days, P = 0.17), and retained stone rate (RR = 1.73, P = 0.38).

Conclusions

One- and two-stage management had similar efficacy and safety in terms of CBD stone clearance rate, mortality, morbidity, operating time, hospital stay, and retained stone rate. One-stage management may reduce additional procedure.

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Acknowledgments

This study was financially supported by National Natural Science Foundation of China (No. 81401954) and Innovation and High-Level Talent Training Program of Department of Health of Zhejiang.

Author contributions

Liang T conceived the idea. Prasson P and Bai X performed the literature search and wrote the first draft of the manuscript. Prasson P and Zhang Q extracted the data. All authors approved the final version.

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    Authors and Affiliations

    1. Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China

      Pankaj Prasson, Xueli Bai, Qi Zhang & Tingbo Liang

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    1. Pankaj Prasson
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    2. Xueli Bai
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    Correspondence to Tingbo Liang.

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    Pankaj Prasson, Xueli Bai, Qi Zhang, Tingbo Liang have no conflicts of interest or financial ties to disclose.

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    Pankaj Prasson and Xueli Bai have contributed equally to this work.

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    Prasson, P., Bai, X., Zhang, Q. et al. One-stage laproendoscopic procedure versus two-stage procedure in the management for gallstone disease and biliary duct calculi: a systemic review and meta-analysis. Surg Endosc 30, 3582–3590 (2016). https://doi.org/10.1007/s00464-015-4657-0

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