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

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.

References

  1. 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(1):28–33. https://doi.org/10.1097/01.sla.0000103069.00170.9c

    Article  PubMed  PubMed Central  Google Scholar 

  2. Tazuma S (2006) Gallstone disease: epidemiology, pathogenesis, and classification of biliary stones (common bile duct and intrahepatic). Best Pract Res Clin Gastroenterol 20(6):1075–1083. https://doi.org/10.1016/j.bpg.2006.05.009

    Article  PubMed  Google Scholar 

  3. European Association for the Study of the Liver. Electronic address eee (2016) EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones. J Hepatol 65 (1):146–181. https://doi.org/10.1016/j.jhep.2016.03.005

    Article  Google Scholar 

  4. Parra-Membrives P, Martinez-Baena D, Lorente-Herce J, Jimenez-Riera G (2018) Comparative study of three bile duct closure methods following laparoscopic common bile duct exploration for choledocholithiasis. J Laparoendosc Adv Surg Tech Part A 28(2):145–151. https://doi.org/10.1089/lap.2017.0433

    Article  Google Scholar 

  5. Quaresima S, Balla A, Guerrieri M, Campagnacci R, Lezoche E, Paganini AM (2017) A 23 year experience with laparoscopic common bile duct exploration. HPB (Oxford) 19(1):29–35. https://doi.org/10.1016/j.hpb.2016.10.011

    Article  Google Scholar 

  6. Zhu HY, Xu M, Shen HJ, Yang C, Li F, Li KW, Shi WJ, Ji F (2015) A meta-analysis of single-stage versus two-stage management for concomitant gallstones and common bile duct stones. Clin Res Hepatol Gastroenterol 39(5):584–593. https://doi.org/10.1016/j.clinre.2015.02.002

    Article  PubMed  Google Scholar 

  7. Dasari BV, Tan CJ, Gurusamy KS, Martin DJ, Kirk G, McKie L, Diamond T, Taylor MA (2013) Surgical versus endoscopic treatment of bile duct stones. Cochrane Database Syst Rev 12:Cd003327. https://doi.org/10.1002/14651858.CD003327.pub4

    Article  Google Scholar 

  8. Natsui M, Saito Y, Abe S, Iwanaga A, Ikarashi S, Nozawa Y, Nakadaira H (2013) Long-term outcomes of endoscopic papillary balloon dilation and endoscopic sphincterotomy for bile duct stones. Dig Endosc 25(3):313–321. https://doi.org/10.1111/j.1443-1661.2012.01393.x

    Article  PubMed  Google Scholar 

  9. Li T, Wen J, Bie L, Gong B (2018) Comparison of the long-term outcomes of endoscopic papillary large balloon dilation alone versus endoscopic sphincterotomy for removal of bile duct stones. Gastroenterol Res Pract. https://doi.org/10.1155/2018/6430701

    Article  PubMed  PubMed Central  Google Scholar 

  10. Ando T, Tsuyuguchi T, Okugawa T, Saito M, Ishihara T, Yamaguchi T, Saisho H (2003) Risk factors for recurrent bile duct stones after endoscopic papillotomy. Gut 52(1):116–121

    CAS  Article  Google Scholar 

  11. Zhao ZH, Hu LH, Ren HB, Zhao AJ, Qian YY, Sun XT, Su S, Zhu SG, Yu J, Zou WB, Guo XR, Wang L, Li ZS, Liao Z (2017) Incidence and risk factors for post-ERCP pancreatitis in chronic pancreatitis. Gastrointest Endosc. https://doi.org/10.1016/j.gie.2016.12.020

    Article  PubMed  Google Scholar 

  12. Lyu Y, Cheng Y, Wang B, Xu Y, Du W (2018) What is impact of nonsteroidal anti-inflammatory drugs in the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: a meta-analysis of randomized controlled trials. BMC Gastroenterol 18(1):106. https://doi.org/10.1186/s12876-018-0837-4

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  13. Vezakis A, Fragulidis G, Polydorou A (2015) Endoscopic retrograde cholangiopancreatography-related perforations: diagnosis and management. World J Gastrointest Endosc 7(14):1135–1141. https://doi.org/10.4253/wjge.v7.i14.1135

    Article  PubMed  PubMed Central  Google Scholar 

  14. Bray MS, Borgert AJ, Folkers ME, Kothari SN (2017) Outcome and management of endoscopic retrograde cholangiopancreatography perforations: a community perspective. Am J Surg 214(1):69–73. https://doi.org/10.1016/j.amjsurg.2017.01.034

    Article  PubMed  Google Scholar 

  15. Mattila A, Mrena J, Kellokumpu I (2017) Cost-analysis and effectiveness of one-stage laparoscopic versus two-stage endolaparoscopic management of cholecystocholedocholithiasis: a retrospective cohort study. BMC Surg 17(1):79. https://doi.org/10.1186/s12893-017-0274-2

    Article  PubMed  PubMed Central  Google Scholar 

  16. Poulose BK, Arbogast PG, Holzman MD (2006) National analysis of in-hospital resource utilization in choledocholithiasis management using propensity scores. Surg Endosc 20(2):186–190. https://doi.org/10.1007/s00464-005-0235-1

    CAS  Article  PubMed  Google Scholar 

  17. Clayton ES, Connor S, Alexakis N, Leandros E (2006) Meta-analysis of endoscopy and surgery versus surgery alone for common bile duct stones with the gallbladder in situ. Br J Surg 93(10):1185–1191. https://doi.org/10.1002/bjs.5568

    CAS  Article  PubMed  Google Scholar 

  18. Singh AN, Kilambi R (2018) Single-stage laparoscopic common bile duct exploration and cholecystectomy versus two-stage endoscopic stone extraction followed by laparoscopic cholecystectomy for patients with gallbladder stones with common bile duct stones: systematic review and meta-analysis of randomized trials with trial sequential analysis. Surg Endosc 32(9):3763–3776. https://doi.org/10.1007/s00464-018-6170-8

    Article  PubMed  Google Scholar 

  19. Wang B, Guo Z, Liu Z, Wang Y, Si Y, Zhu Y, Jin M (2013) Preoperative versus intraoperative endoscopic sphincterotomy in patients with gallbladder and suspected common bile duct stones: system review and meta-analysis. Surg Endosc 27(7):2454–2465. https://doi.org/10.1007/s00464-012-2757-7

    Article  PubMed  Google Scholar 

  20. El Nakeeb A, El Geidie A, El Hanafy E, Atef E, Askar W, Sultan AM, Hamdy E, El Shobary M, Hamed H, Abdelrafee A, Zeid MA (2016) Management and outcome of borderline common bile duct with stones: a prospective randomized study. J Laparoendosc Adv Surg Tech Part A 26(3):161–167. https://doi.org/10.1089/lap.2015.0493

    Article  Google Scholar 

  21. Lv S, Fang Z, Wang A, Yang J, Zhu Y (2015) One-step LC and ERCP treatment of 40 Cases with cholelithiasis complicated with common bile duct stones. Hepatogastroenterology 62(139):570–572

    PubMed  Google Scholar 

  22. Higgins JPT, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savović J, Schulz KF, Weeks L, Sterne JAC (2011) The Cochrane collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928–d5928

    Article  Google Scholar 

  23. Ferulano 2011.pdf.

  24. Bansal VK, Misra MC, Garg P, Prabhu M (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(8):1986–1989. https://doi.org/10.1007/s00464-010-0891-7

    Article  PubMed  Google Scholar 

  25. Bansal VK, Misra MC, Rajan K, Kilambi R, Kumar S, Krishna A, Kumar A, Pandav CS, Subramaniam R, Arora MK, Garg PK (2014) Single-stage laparoscopic common bile duct exploration and cholecystectomy versus two-stage endoscopic stone extraction followed by laparoscopic cholecystectomy for patients with concomitant gallbladder stones and common bile duct stones: a randomized controlled trial. Surg Endosc 28(3):875–885. https://doi.org/10.1007/s00464-013-3237-4

    Article  PubMed  Google Scholar 

  26. Barreras Gonzalez JE, Torres Pena R, Ruiz Torres J, Martinez Alfonso MA, Brizuela Quintanilla R, Morera Perez M (2016) Endoscopic versus laparoscopic treatment for choledocholithiasis: a prospective randomized controlled trial. Endosc Int Open 4(11):E1188–E1193. https://doi.org/10.1055/s-0042-116144

    Article  PubMed  PubMed Central  Google Scholar 

  27. Cuschieri A, Lezoche E, Morino M, Croce E, Lacy A, Toouli J, Faggioni A, Ribeiro VM, Jakimowicz J, Visa J, Hanna GB (1999) E.A.E.S. multicenter prospective randomized trial comparing two-stage vs single-stage management of patients with gallstone disease and ductal calculi. Surg Endosc 13(10):952–957

    CAS  Article  Google Scholar 

  28. Ding G, Cai W, Qin M (2014) Single-stage vs. two-stage management for concomitant gallstones and common bile duct stones: a prospective randomized trial with long-term follow-up. J Gastrointest Surg 18(5):947–951. https://doi.org/10.1007/s11605-014-2467-7

    Article  PubMed  Google Scholar 

  29. Koc B, Karahan S, Adas G, Tutal F, Guven H, Ozsoy A (2013) Comparison of laparoscopic common bile duct exploration and endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy for choledocholithiasis: a prospective randomized study. Am J Surg 206(4):457–463. https://doi.org/10.1016/j.amjsurg.2013.02.004

    Article  PubMed  Google Scholar 

  30. Lv F, Zhang S, Ji M, Wang Y, Li P, Han W (2016) Single-stage management with combined tri-endoscopic approach for concomitant cholecystolithiasis and choledocholithiasis. Surg Endosc 30(12):5615–5620. https://doi.org/10.1007/s00464-016-4918-6

    Article  PubMed  PubMed Central  Google Scholar 

  31. Noble H, Tranter S, Chesworth T, Norton S, Thompson M (2009) A randomized, clinical trial to compare endoscopic sphincterotomy and subsequent laparoscopic cholecystectomy with primary laparoscopic bile duct exploration during cholecystectomy in higher risk patients with choledocholithiasis. J Laparoendosc Adv Surg Tech Part A 19(6):713–720. https://doi.org/10.1089/lap.2008.0428

    Article  Google Scholar 

  32. Rogers SJ, Cello JP, Horn JK, Siperstein AE, Schecter WP, Campbell AR, Mackersie RC, Rodas A, Kreuwel HT, Harris HW (2010) Prospective randomized trial of LC + LCBDE vs ERCP/S + LC for common bile duct stone disease. Arch Surg 145(1):28–33. https://doi.org/10.1001/archsurg.2009.226

    Article  PubMed  Google Scholar 

  33. Sgourakis G, Karaliotas K (2002) Laparoscopic common bile duct exploration and cholecystectomy versus endoscopic stone extraction and laparoscopic cholecystectomy for choledocholithiasis. A prospective randomized study. Minerva Chirurgica 57(4):467–474

    CAS  PubMed  Google Scholar 

  34. Lu J, Cheng Y, Xiong XZ, Lin YX, Wu SJ, Cheng NS (2012) Two-stage vs single-stage management for concomitant gallstones and common bile duct stones. World J Gastroenterol 18(24):3156–3166. https://doi.org/10.3748/wjg.v18.i24.3156

    Article  PubMed  PubMed Central  Google Scholar 

  35. Pan L, Chen M, Ji L, Zheng L, Yan P, Fang J, Zhang B, Cai X (2018) The safety and efficacy of laparoscopic common bile duct exploration combined with cholecystectomy for the management of cholecysto-choledocholithiasis: an up-to-date meta-analysis. Ann Surg 268(2):247–253. https://doi.org/10.1097/SLA.0000000000002731

    Article  PubMed  Google Scholar 

  36. ElGeidie A, Atif E, Naeem Y, ElEbidy G (2015) Laparoscopic bile duct clearance without choledochoscopy. Surg Laparosc Endosc Percutan Tech 25(5):e152–e155. https://doi.org/10.1097/sle.0000000000000198

    Article  PubMed  Google Scholar 

  37. Siiki A, Laukkarinen J (2017) Can we prevent post-ERCP pancreatitis? Duodecim 133(3):267–274

    PubMed  Google Scholar 

  38. Podda M, Polignano FM, Luhmann A, Wilson MS, Kulli C, Tait IS (2016) Systematic review with meta-analysis of studies comparing primary duct closure and T-tube drainage after laparoscopic common bile duct exploration for choledocholithiasis. Surg Endosc 30(3):845–861. https://doi.org/10.1007/s00464-015-4303-x

    Article  PubMed  Google Scholar 

  39. Gurusamy KS, Koti R, Davidson BR (2013) T-tube drainage versus primary closure after laparoscopic common bile duct exploration. Cochrane Database Syst Rev 6:Cd005641. https://doi.org/10.1002/14651858.CD005641.pub3

    Article  Google Scholar 

  40. Lezoche E, Paganini AM (1995) Single-stage laparoscopic treatment of gallstones and common bile duct stones in 120 unselected, consecutive patients. Surg Endosc 9(10):1070–1075

    CAS  Article  Google Scholar 

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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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Cite this article

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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  • DOI: https://doi.org/10.1007/s00464-018-06613-w

Keywords

  • Common bile duct stones
  • Laparoscopic common bile duct exploration
  • Laparoscopic cholecystectomy
  • Endoscopic retrograde cholangiopancreatography
  • Meta-analysis
  • Systematic review