World Journal of Surgery

, Volume 37, Issue 5, pp 999–1005 | Cite as

Routine Use of Simultaneous Laparoendoscopic Approach in Patients with Confirmed Gallbladder and Bile Duct Stones: Fit for Laparoscopy Fit for “Rendezvous”

  • Cinzia Tommasi
  • Lapo Bencini
  • Marco Bernini
  • Riccardo Naspetti
  • Giulia Cavallina
  • Roberto Manetti
  • Luca Talamucci
  • Marco Farsi



The aim of the present work was to determine the feasibility and efficacy, in terms of equipment coordination and timing, of the laparoendoscopic intraoperative rendezvous technique (RVT) for the treatment of gallbladder and common bile duct stones (CBDS).


The procedure was considered in 269 unselected patients with a suspicion or preoperative imaging demonstration of CBDS who were fit for laparoscopic cholecystectomy (LC). Common bile duct stones were confirmed by intraoperative laparoscopic cholangiography (IOC) in only 113 of these patients (42 %). In 17 (15 %) patients the planned procedure was aborted because of organizational problems, mainly the unavailability of endoscopists in the urgent setting. The remaining 96 patients (84 %) underwent a formal attempt at RVT. Intraoperative endoscopic retrograde cholangiography (ERC) was performed, during LC, by means of a guidewire that reached the duodenum through the cystic duct.


In 18 patients (19 %) the complete procedure failed, either because of difficulty in passing the guidewire through the papilla or because of other technical difficulties that required conversion to laparotomy. An intraoperative ERC was completed in six patients in the classical way (no guidewire) without conversion. No mortality and few complications were recorded (3 % overall: 1 perforation and 2 cholangitis). Retained stones were successively detected in 6 patients (6 %) and successfully retreated by a further ERC. Globally, the one-stage procedure (with and without the guidewire) was possible in 84 of 96 patients (87 %).


The RVT appears to be effective and safe as it was performed at our institution, with an overall percentage of definitive success (passed guide wire and no further ERC) of 81 %. The RVT should be considered as a good option for the treatment of simultaneous gallstones and CBDS.


  1. 1.
    Ko CW, Lee SP (2002) Epidemiology and natural history of common bile duct stones and prediction of disease. The NIH State-of-the-Science Conference: ERCP for diagnosis and therapy. Gastrointest Endosc 56:165–169CrossRefGoogle Scholar
  2. 2.
    NIH Consensus Conference (1993) Gallstones and laparoscopic cholecystectomy. JAMA 269:1018–1024CrossRefGoogle Scholar
  3. 3.
    Sain AH (1996) Laparoscopic cholecystectomy is the current “gold standard” for the treatment of gallstone disease. Ann Surg 224:689–690PubMedCrossRefGoogle Scholar
  4. 4.
    Williams EJ, Green J, Beckingham I et al (2008) Guidelines on the management of common bile duct stones (CBDS). Gut 57:1004–1021PubMedCrossRefGoogle Scholar
  5. 5.
    Wills VL, Gibson K, Karihaloot C et al (2002) Complications of biliary T-tubes after choledochotomy. ANZJ Surg 72:177–180CrossRefGoogle Scholar
  6. 6.
    Parra-Membrives P, Díaz-Gómez D, Vilegas-Portero R et al (2010) Appropriate management of common bile duct stones: a RAND Corporation/UCLA Appropriateness Method statistical analysis. Surg Endosc 24:1187–1194PubMedCrossRefGoogle Scholar
  7. 7.
    Clayton E, Connor S, Alexakis N et al (2006) Metaanalysis of endoscopy and surgery versus surgery alone for common bile duct stones with the gallbladder in situ. Br J Surg 93:1185–1191PubMedCrossRefGoogle Scholar
  8. 8.
    Poulose B, Arbogast P, Holzman M (2006) National analysis of in-hospital resource utilization in choledocholithiasis management using propensity scores. Surg Endosc 20:186–190PubMedCrossRefGoogle Scholar
  9. 9.
    Gholipour C, Shalchi RA, Abassi M (2007) Efficacy and safety of early laparoscopic common bile duct exploration as primary procedure in acute cholangitis caused by common bile duct stones. J Laparoendosc Adv Surg Tech 17:634–638CrossRefGoogle Scholar
  10. 10.
    Vila JJ, Artifon EL, Otoch JP (2012) Post-endoscopic retrograde cholangiopancreatography complications: how can they be avoided? World J Gastrointest Endosc 16:241–246CrossRefGoogle Scholar
  11. 11.
    Prat F, Edery J, Meduri B et al (2001) Early EUS of the bile duct before endoscopic sphincterotomy for acute biliary pancreatitis. Gastrointest Endosc 54:724–729PubMedCrossRefGoogle Scholar
  12. 12.
    Liu CL, Lo CM, Chan JK et al (2001) Detection of choledocholithiasis by EUS in acutepancreatitis: a prospective evaluation in 100 consecutive patients. Gastrointest Endosc 54:325–330PubMedCrossRefGoogle Scholar
  13. 13.
    Makary MA, Duncan MD, Harmon J et al (2005) The role of magnetic resonance cholangiography in the management of patients with gallstone pancreatitis. Ann Surg 241:119–124PubMedGoogle Scholar
  14. 14.
    Berthou JCh, Dron B, Charbonneau P et al (2007) Evaluation of laparoscopic treatment of common bile duct stones in a prospective series of 505 patients: indications and results. Surg Endosc 21:1970–1974PubMedCrossRefGoogle Scholar
  15. 15.
    Bahram M, Gaballa G (2010) The value of pre-operative magnetic resonance cholangiopancreatography (MRCP) in management of patients with gall stones. Int J Surg 8:342–345PubMedCrossRefGoogle Scholar
  16. 16.
    Yang MH, Chen TH, Wang SE et al (2008) Biochemical predictors for absence of common bile duct stones in patients undergoing laparoscopic cholecystectomy. Surg Endosc 22:1620–1624PubMedCrossRefGoogle Scholar
  17. 17.
    Tekin A, Ogetman Z, Altunel E (2008) Laparoendoscopic “rendezvous” versus laparoscopic antegrade sphincterotomy for choledocholithiasis. Surgery 144:442–447PubMedCrossRefGoogle Scholar
  18. 18.
    Borzellino G, Rodella L, Saladino E et al (2010) Treatment for retained common bile duct stones during laparoscopic cholecystectomy. The rendezvous technique. Arch Surg 145:1145–1149PubMedCrossRefGoogle Scholar
  19. 19.
    Deslandres E, Gagner M, Pomp A et al (1993) Intraoperative endoscopic sphincterotomy for common bile duct stones during laparoscopic cholecystectomy. Gastrointest Endosc 39:54–58PubMedCrossRefGoogle Scholar
  20. 20.
    Mayrhofer T, Schmiederer R, Razek P (1993) Intraoperative endoscopic papillotomy and stone removal. Endosc Surg Allied Technol 1:144–149PubMedGoogle Scholar
  21. 21.
    Feretis C, Kalliakmanis B, Benakis P et al (1994) Laparoscopic transcystic papillotomy under endoscopic control for bile duct stones. Endoscopy 26:697–700PubMedCrossRefGoogle Scholar
  22. 22.
    Miscusi G, Gasparrini M, Petruzziello L et al (1997) Endolaparoscopic “Rendez-vous” in the treatment of cholecysto-choledochalcalculosis. G Chir 18:655–657PubMedGoogle Scholar
  23. 23.
    Treckman J, Sauerland S, Frilling A et al (2006) Common bile duct stones—update 2006. In: Neugebauer E, Sauerland S, Fingerhut A et al (eds) EAES guidelines for endoscopic surgery—twelve years evidence-based surgery in Europe. Springer, Berlin, pp 329–333CrossRefGoogle Scholar
  24. 24.
    Martin DJ, Vernon DR, Toouli J (2006) Surgical versus endoscopic treatment of bile duct stones. Cochrane Database Syst Rev 2:CD003327Google Scholar
  25. 25.
    Arata S, Takada T, Hirata K et al (2010) Post-ERCP pancreatitis. J Hepatobiliary Pancreat Sci 17:70–78PubMedCrossRefGoogle Scholar
  26. 26.
    Rogers SJ, Cello JP, Horn J et al (2010) Prospective randomized trial of LC+LCBDE vs ERCP/S+LC for common bile duct stone disease. Arch Surg 145:28–33PubMedCrossRefGoogle Scholar
  27. 27.
    Bansal VK, Misra MC, Garg P et al (2010) A prospective randomized trial comparing two-stage versus single-stage management of patients with gallstone disease and common bile duct stones. Surg Endosc 24:1986–1989PubMedCrossRefGoogle Scholar
  28. 28.
    Morino M, Baracchi F, Miglietta C et al (2006) Preoperative endoscopic sphincterotomy versus laparoendoscopic rendezvous in patients with gallbladder and bile duct stones. Ann Surg 244:889–896PubMedCrossRefGoogle Scholar
  29. 29.
    Costi R, Mazzeo A, Tartamella F et al (2010) Cholecystocholedocholithiasis: a case–control study comparing the short- and long-term outcomes for a “laparoscopy-first” attitude with the outcome for sequential treatment (systematic endoscopic sphincterotomy followed by laparoscopic cholecystectomy). Surg Endosc 24:51–62PubMedCrossRefGoogle Scholar
  30. 30.
    Hanif F, Ahmed Z, Samie MA et al (2010) Laparoscopic transcystic bile duct exploration: the treatment of first choice for common bile duct stones. Surg Endosc 24:1552–1556PubMedCrossRefGoogle Scholar
  31. 31.
    Duncan CB, Riall TS (2012) Evidence-based current surgical practice: calculous gallbladder disease. J Gastrointest Surg 16:2011–2025PubMedCrossRefGoogle Scholar
  32. 32.
    Tringali A, Mutignani M, Milano A et al (2008) No difference between supine and prone position for ERCP in conscious sedated patients: a prospective randomized study. Endoscopy 40:93–97PubMedCrossRefGoogle Scholar
  33. 33.
    Rábago LR, Chico I, Collado D et al (2012) Single-stage treatment with intraoperative ERCP: management of patients with possible choledocholithiasis and gallbladder in situ in a non-tertiary Spanish hospital. Surg Endosc 26:1028–1034PubMedCrossRefGoogle Scholar
  34. 34.
    La Greca G, Barbagallo F, Di Blasi M et al (2008) Laparo-endoscopic “rendez-vous” to treat cholecysto-choledocholithiasis: effective, safe and simplifies the endoscopist’s work. World J Gastroenterol 14:2844–2850PubMedCrossRefGoogle Scholar
  35. 35.
    Cemachovic I, Letard JC, Begin GF et al (2000) Intraoperative endoscopic sphincterotomy is a reasonable option for complete single-stage minimally invasive biliary stones treatment: short-term experience with 57 patients. Endoscopy 32:956–962PubMedCrossRefGoogle Scholar
  36. 36.
    Wei Q, Wang JG, Li LB et al (2003) Management of choledocholithiasis: comparison between laparoscopic common bile duct exploration and intraoperative endoscopic sphincterotomy. World J Gastroenterol 9:2856–2858PubMedGoogle Scholar
  37. 37.
    Saccomani G, Durante V, Magnolia MR et al (2005) Combined endoscopic treatment for cholelithiasis associated with choledocholithiasis. Surg Endosc 19:910–914PubMedCrossRefGoogle Scholar
  38. 38.
    La Greca G, Barbagallo F, Di Blasi M et al (2007) Rendezvous technique versus endoscopic retrograde cholangiopancreatography to treat bile duct stones reduces endoscopic time and pancreatic damage. J Laparoendosc Adv Surg Tech A 17:167–171PubMedCrossRefGoogle Scholar
  39. 39.
    Hong DF, Xin Y, Chen DW (2006) Comparison of laparoscopic cholecystectomy combined with intraoperative endoscopic sphincterotomy and laparoscopic exploration of the common bile duct for cholecystocholedocholithiasis. Surg Endosc 20:424–427PubMedCrossRefGoogle Scholar
  40. 40.
    Topal B, Vromman K, Aerts R et al (2010) Hospital cost categories of one-stage versus two-stage management of common bile duct stones. Surg Endosc 24:413–416PubMedCrossRefGoogle Scholar
  41. 41.
    Gurusamy K, Sahay SJ, Burroughs AK et al (2011) Systematic review and meta-analysis of intraoperative versus preoperative endoscopic sphincterotomy in patients with gallbladder and suspected common bile duct stones. Br J Surg 98:908–916PubMedCrossRefGoogle Scholar
  42. 42.
    Sanjay P, Kulli C, Polignano FM et al (2010) Optimal surgical technique, use of intra-operative cholangiography (IOC), and management of acute gallbladder disease: the results of a nation-wide survey in the UK and Ireland. Ann R Coll Surg Engl 92:302–306PubMedCrossRefGoogle Scholar
  43. 43.
    Sajid MS, Leaver C, Haider Z et al (2012) Routine on-table cholangiography during cholecystectomy: a systematic review. Ann R Coll Surg Engl 94:375–380PubMedCrossRefGoogle Scholar
  44. 44.
    Rábago LR, Vicente C, Soler F et al (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 38:779–786PubMedCrossRefGoogle Scholar
  45. 45.
    Lu J, Cheng Y, Xiong XZ et al (2012) Two-stage vs single-stage management for concomitant gallstones and common bile duct stones. World J Gastroenterol 18:3156–3166PubMedCrossRefGoogle Scholar
  46. 46.
    Enochsson L, Lindberg B, Swahn F et al (2004) Intraoperative endoscopic retrograde cholangiopancreatography (ERCP) to remove common bile duct stones during routine laparoscopic cholecystectomy does not prolong hospitalization. Surg Endosc 18:367–371PubMedCrossRefGoogle Scholar
  47. 47.
    Lella F, Bagnolo F, Rebuffat C et al (2006) Use of the laparoscopic–endoscopic approach, the so-called “rendez-vous” technique, in cholecystocholedocholithiasis. Surg Endosc 20:419–423PubMedCrossRefGoogle Scholar
  48. 48.
    Tzovaras G, Baloyiannis I, Zachari E et al (2012) Laparoendoscopic rendezvous versus preoperative ERCP and laparoscopic cholecystectomy for the management of cholecysto-choledocholithiasis: interim analysis of a controlled randomized trial. Ann Surg 255:435–439PubMedCrossRefGoogle Scholar
  49. 49.
    La Greca G, Barbagallo F, Sofia M et al (2010) Simultaneous laparoendoscopic rendezvous for the treatment of cholecystocholedocholithiasis. Surg Endosc 24:769–780CrossRefGoogle Scholar
  50. 50.
    Tzovaras G, Baloyiannis I, Kapsoritakis A et al (2010) Laparoendoscopic rendezvous: an effective alternative to a failed preoperative ERCP in patients with cholecystocholedocholithiasis. Surg Endosc 24:2603–2606PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2013

Authors and Affiliations

  • Cinzia Tommasi
    • 1
  • Lapo Bencini
    • 1
    • 2
  • Marco Bernini
    • 1
  • Riccardo Naspetti
    • 1
  • Giulia Cavallina
    • 1
  • Roberto Manetti
    • 1
  • Luca Talamucci
    • 1
  • Marco Farsi
    • 1
  1. 1.Surgical Oncology, Surgical and Flexible Endoscopic UnitCareggi University HospitalFlorenceItaly
  2. 2.Oncologic Surgery, Department of OncologyAzienda Ospedaliero-Universitaria di CareggiFlorenceItaly

Personalised recommendations