Laparoscopic common bile duct exploration versus intraoperative endoscopic retrograde cholangiopancreatography in patien
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and Other Interventional Techniques
REVIEW ARTICLE
Laparoscopic common bile duct exploration versus intraoperative endoscopic retrograde cholangiopancreatography in patients with gallbladder and common bile duct stones: a meta‑analysis Jisheng Zhu1 · Guoyong Li1 · Peng Du1 · Xin Zhou1 · Weidong Xiao1 · Yong Li1 Received: 23 April 2020 / Accepted: 26 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background To compare the efficacy and safety of laparoscopic common bile duct exploration plus laparoscopic cholecystectomy (LCBDE + LC) with intraoperative endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy (IO-ERCP + LC) for the treatment of gallbladder and common bile duct (CBD) stones. Methods We searched PubMed, Ovid, and Cochrane Library from their inception dates to April 2020, for studies that compared the efficacy and safety of LCBDE + LC with those of IO-ERCP + LC in patients with gallbladder and CBD stones. The technical success, morbidity, major morbidity, biliary leak, postoperative pancreatitis, conversion, retained stones, operative time, and postoperative hospital stay were compared between these two approaches. Results Five randomized controlled trials involving 860 patients were evaluated. Overall, no significant difference was found between LCBDE + LC and IO-ERCP + LC regarding technical success, morbidity, major morbidity, and the conversion rate. Biliary leak and retained stones were significantly more prevalent in the LCBDE + LC group, while postoperative pancreatitis was significantly more prevalent in the IO-ERCP + LC group. Conclusions LCBDE + LC and IO-ERCP + LC have similar efficacy and safety in terms of technical success, morbidity, major morbidity, and conversion rate. However, LCBDE + LC is associated with a higher biliary leak rate, lower postoperative pancreatitis rate, and higher rate of retained stones. Keywords Common bile duct stones · Laparoscopic common bile duct exploration · Endoscopic retrograde cholangiopancreatography · Meta-analysis Choledocholithiasis, the presence of stones in the common bile duct (CBD), is prevalent in 10–20% of individuals with symptomatic gallstones [1]. To avoid serious complications, these calculuses should be cleaned. At present, a variety of minimally invasive management modalities can be employed to remove the cholelithiasis and choledocholithiasis. These methods include endoscopic retrograde cholangiopancreatography (ERCP) before or after laparoscopic cholecystectomy (LC), intraoperative ERCP plus LC (IO-ERCP + LC), and laparoscopic common bile duct exploration (LCBDE) with LC [2]. The preferred strategy for managing gallbladder * Yong Li [email protected] 1
Department of General Surgery, The First Affiliated Hospital of Nanchang University, No.17 Yongwai Zhengjie, Nanchang 330006, Jiangxi, China
and CBD stones in the world is preoperative ERCP combined with LC [3]. However, this approach has some drawbacks, such as it requires two anesthesia and sometimes two admis
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