Laparoscopic cholecystectomy plus laparoscopic common bile duct exploration compared with laparoscopic cholecystectomy plus endoscopic retrograde cholangiopancreato-graphy for patients with concomitant cholelithiasis and choledocholithiasis: a meta-analysis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Xin ,  YUAN Qi , GAO Pengcheng

Department of General Surgery, Zhangye People's Hospital of Hexi College, Zhangye, Gansu 734000, P. R. China;

Corresponding author：

YUAN Qi, Email: a13689363739@163.com

Keywords：

choledocholithiasis; laparoscopic cholecystectomy; laparoscopic common bile duct exploration; endoscopic retrograde cholangiopancreatography; meta-analysis

DOI：

10.7507/1007-9424.201904047

Video：

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Objective To compare the effectiveness and safety of laparoscopic cholecystectomy (LC) plus laparoscopic common bile duct exploration (LCBDE) with LC plus endoscopic retrograde cholangiopancreatography (ERCP) for patients with concomitant cholelithiasis and choledocholithiasis by using meta-analysis.Methods We searched PubMed, Cochrane Library、EMBASE, Chinese Biomedical Literature Database, Chinese Science and Technology Academic Journal, Chinese Journal Full-text Database and Wanfang database to identify relevant articles from their inception to 31 October 2018. A meta-analysis was carried out using the RevMan 5.3 software.Results A total of 13 RCTs were included in this meta-analysis, 747 cases received LC+LCBDE and 761 cases underwent LC+ERCP. The meta-analysis results showed that no significant difference between the LC+LCBDE group and the LC+ERCP group in terms of common bile duct (CBD) stone clearance rate [RR=0.99, 95%CI (0.95, 1.02), P=0.87] and overall complications [RR=0.94, 95%CI (0.72, 1.22), P=0.64]. The LC+LCBDE group had higher rate of postoperative bile leakage rate [RR=3.87, 95%CI (2.01, 7.42), P<0.000 1] than that LC+ERCP group. However, the LC+LCBDE group had lower rate of postoperative pancreatitis [RR=0.28, 95%CI (0.14, 0.55), P=0.002] than that LC+ERCP group.Conclusions Both LC+LCBDE and LC+ERCP are equivalent in CBD stone clearance rate and overall complications, LC+LCBDE is associated with a higher postoperative bile leakage rate and lower rate of postoperative pancreatitis, appropriate treatment should be selected according to the individual patient’s condition.

Citation： ZHANG Xin, YUAN Qi, GAO Pengcheng. Laparoscopic cholecystectomy plus laparoscopic common bile duct exploration compared with laparoscopic cholecystectomy plus endoscopic retrograde cholangiopancreato-graphy for patients with concomitant cholelithiasis and choledocholithiasis: a meta-analysis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(10): 1209-1216. doi: 10.7507/1007-9424.201904047 Copy

1.	Parra-Membrives P, Martínez-Baena D, Lorente-Herce J, et al. Comparative Study of three bile duct closure methods following laparoscopic common bile duct exploration for choledocholithiasis. J Laparoendosc Adv Surg Tech A, 2018, 28(2): 145-151.
2.	Wandling MW, Hungness ES, Pavey ES, et al. Nationwide assessment of trends in choledocholithiasis management in the united States from 1998 to 2013. JAMA Surg, 2016, 151(12): 1125-1130.
3.	Bray MS, Borgert AJ, Folkers ME, et al. Outcome and management of endoscopic retrograde cholangiopancreatography perforations: A community perspective. Am J Surg, 2017, 214(1): 69-73.
4.	Becker LA, Oxman AD. Chapter 22: Overviews of reviews. //Higgings JPT, Green S. ed. The Cochrane Handbook for Systematic Reviews of Interventions Virsion5. 1. 0[updated March 2011] the Cochrane Collaboration 2011, http://handbook.cochrane.org/chapter_22/22_overviews_of_reviews.htm.
5.	Cuschieri A, Lezoche E, Morino M, et al. 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, 1999, 13(10): 952-957.
6.	Sgourakis G, Karaliotas K. Laparoscopic common bile duct exploration and cholecystectomy versus endoscopic stone extraction and laparoscopic cholecystectomy for choledo-cholithiasis. A prospective randomized study. Minerva Chir, 2002, 57(4): 467-474.
7.	Noble H, Tranter S, Chesworth T, et al. 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 A, 2009, 19(6): 713-720.
8.	Rogers SJ, Cello JP, Horn JK, et al. Prospective randomized trial of LC+LCBDE vs ERCP/S+LC for common bile duct stone disease. Arch Surg, 2010, 145(1): 28-33.
9.	Bansal VK, Misra MC, Garg P, et al. A prospective randomized trial comparing two-stage versus single-stage management of patients with gallstone disease and common bile duct stones. Surg Endosc, 2010, 24(8): 1986-1989.
10.	Koc B, Karahan S, Adas G, et al. Comparison of laparoscopic common bile duct exploration and endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy for choledocholithiasis: a prospective randomized study. Am J Surg, 2013, 206(4): 457-463.
11.	Ding G, Cai W, Qin M. 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, 2014, 18(5): 947-951.
12.	Bansal VK, Misra MC, Rajan K, et al. 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, 2014, 28(3): 875-885.
13.	Lv F, Zhang S, Ji M, et al. Single-stage management with combined tri-endoscopic approach for concomitant cholecystolithiasis and choledocholithiasis. Surg Endosc, 2016, 30(12): 5615-5620.
14.	Barreras González JE, Torres Peña R, Ruiz Torres J, et al. Endoscopic versus laparoscopic treatment for choledocholithiasis: a prospective randomized controlled trial. Endosc Int Open, 2016, 4(11): E1188-E1193.
15.	El Nakeeb A, El Geidie A, El Hanafy E, et al. Management and outcome of borderline common bile duct with stones: a prospective rRandomized study. J Laparoendosc Adv Surg Tech A, 2016, 26(3): 161-167.
16.	张烨, 孙加林, 胡行前, 等. 腹腔镜胆囊切除术联合胆总管探查术与经内镜逆行胰胆管造影联合腹腔镜胆囊切除术的比较. 临床外科杂志, 2017, 25(6): 434-436.
17.	古广强, 李波, 万祎, 等. 腹腔镜胆囊切除联合术中内镜逆行胰胆管造影治疗老年胆囊结石合并胆总管结石. 中国普通外科杂志, 2018, 27(8): 968-975.
18.	游蓁, 叶辉, 熊先泽, 等. LC+LCBDE 与 ERCP/EST+LC 治疗胆囊结石合并胆总管结石的梗阻性黄疸患者的临床对照研究. 中国普外基础与临床杂志, 2013, 20(11): 1268-1271.
19.	陈盛, 郑江华, 区应亮, 等. 两种微创方式治疗胆囊结石合并胆总管结石的临床疗效比较. 中国普外基础与临床杂志, 2012, 19(11): 1213-1217.
20.	Zhu HY, Xu M, Shen HJ, et al. A meta-analysis of single-stage versus two-stage management for concomitant gallstones and common bile duct stones. Clin Res HepatolGastroenterol, 2015, 39(5): 584-593.
21.	谭向龙, 薛瑞华, 王大东. ERCP 与腹腔镜胆总管探查治疗胆囊结石合并胆总管结石的比较. 中华腔镜外科杂志 (电子版), 2016, 9(1): 37-40.
22.	Vettoretto N, Arezzo A, Famiglietti F, et al. Laparoscopic-endoscopic rendezvous versus preoperative endoscopic sphincterotomy in people undergoing laparoscopic cholecystectomy for stones in the gallbladder and bile duct. Cochrane Database Syst Rev, 2018, 4: CD010507.
23.	Kochar B, Akshintala VS, Afghani E, et al. Incidence, severity, and mortality of post-ERCP pancreatitis: a systematic review by using randomized, controlled trials. Gastrointest Endosc, 2015, 81(1): 143-149, e149.
24.	Swahn F, Nilsson M, Arnelo U, et al. Rendezvous cannulation technique reduces post-ERCP pancreatitis: a prospective nationwide study of 12 718 ERCP procedures. Am J Gastroenterol, 2013, 108(4): 552-559.

1. Parra-Membrives P, Martínez-Baena D, Lorente-Herce J, et al. Comparative Study of three bile duct closure methods following laparoscopic common bile duct exploration for choledocholithiasis. J Laparoendosc Adv Surg Tech A, 2018, 28(2): 145-151.
2. Wandling MW, Hungness ES, Pavey ES, et al. Nationwide assessment of trends in choledocholithiasis management in the united States from 1998 to 2013. JAMA Surg, 2016, 151(12): 1125-1130.
3. Bray MS, Borgert AJ, Folkers ME, et al. Outcome and management of endoscopic retrograde cholangiopancreatography perforations: A community perspective. Am J Surg, 2017, 214(1): 69-73.
4. Becker LA, Oxman AD. Chapter 22: Overviews of reviews. //Higgings JPT, Green S. ed. The Cochrane Handbook for Systematic Reviews of Interventions Virsion5. 1. 0[updated March 2011] the Cochrane Collaboration 2011, http://handbook.cochrane.org/chapter_22/22_overviews_of_reviews.htm.
5. Cuschieri A, Lezoche E, Morino M, et al. 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, 1999, 13(10): 952-957.
6. Sgourakis G, Karaliotas K. Laparoscopic common bile duct exploration and cholecystectomy versus endoscopic stone extraction and laparoscopic cholecystectomy for choledo-cholithiasis. A prospective randomized study. Minerva Chir, 2002, 57(4): 467-474.
7. Noble H, Tranter S, Chesworth T, et al. 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 A, 2009, 19(6): 713-720.
8. Rogers SJ, Cello JP, Horn JK, et al. Prospective randomized trial of LC+LCBDE vs ERCP/S+LC for common bile duct stone disease. Arch Surg, 2010, 145(1): 28-33.
9. Bansal VK, Misra MC, Garg P, et al. A prospective randomized trial comparing two-stage versus single-stage management of patients with gallstone disease and common bile duct stones. Surg Endosc, 2010, 24(8): 1986-1989.
10. Koc B, Karahan S, Adas G, et al. Comparison of laparoscopic common bile duct exploration and endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy for choledocholithiasis: a prospective randomized study. Am J Surg, 2013, 206(4): 457-463.
11. Ding G, Cai W, Qin M. 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, 2014, 18(5): 947-951.
12. Bansal VK, Misra MC, Rajan K, et al. 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, 2014, 28(3): 875-885.
13. Lv F, Zhang S, Ji M, et al. Single-stage management with combined tri-endoscopic approach for concomitant cholecystolithiasis and choledocholithiasis. Surg Endosc, 2016, 30(12): 5615-5620.
14. Barreras González JE, Torres Peña R, Ruiz Torres J, et al. Endoscopic versus laparoscopic treatment for choledocholithiasis: a prospective randomized controlled trial. Endosc Int Open, 2016, 4(11): E1188-E1193.
15. El Nakeeb A, El Geidie A, El Hanafy E, et al. Management and outcome of borderline common bile duct with stones: a prospective rRandomized study. J Laparoendosc Adv Surg Tech A, 2016, 26(3): 161-167.
16. 张烨, 孙加林, 胡行前, 等. 腹腔镜胆囊切除术联合胆总管探查术与经内镜逆行胰胆管造影联合腹腔镜胆囊切除术的比较. 临床外科杂志, 2017, 25(6): 434-436.
17. 古广强, 李波, 万祎, 等. 腹腔镜胆囊切除联合术中内镜逆行胰胆管造影治疗老年胆囊结石合并胆总管结石. 中国普通外科杂志, 2018, 27(8): 968-975.
18. 游蓁, 叶辉, 熊先泽, 等. LC+LCBDE 与 ERCP/EST+LC 治疗胆囊结石合并胆总管结石的梗阻性黄疸患者的临床对照研究. 中国普外基础与临床杂志, 2013, 20(11): 1268-1271.
19. 陈盛, 郑江华, 区应亮, 等. 两种微创方式治疗胆囊结石合并胆总管结石的临床疗效比较. 中国普外基础与临床杂志, 2012, 19(11): 1213-1217.
20. Zhu HY, Xu M, Shen HJ, et al. A meta-analysis of single-stage versus two-stage management for concomitant gallstones and common bile duct stones. Clin Res HepatolGastroenterol, 2015, 39(5): 584-593.
21. 谭向龙, 薛瑞华, 王大东. ERCP 与腹腔镜胆总管探查治疗胆囊结石合并胆总管结石的比较. 中华腔镜外科杂志 (电子版), 2016, 9(1): 37-40.
22. Vettoretto N, Arezzo A, Famiglietti F, et al. Laparoscopic-endoscopic rendezvous versus preoperative endoscopic sphincterotomy in people undergoing laparoscopic cholecystectomy for stones in the gallbladder and bile duct. Cochrane Database Syst Rev, 2018, 4: CD010507.
23. Kochar B, Akshintala VS, Afghani E, et al. Incidence, severity, and mortality of post-ERCP pancreatitis: a systematic review by using randomized, controlled trials. Gastrointest Endosc, 2015, 81(1): 143-149, e149.
24. Swahn F, Nilsson M, Arnelo U, et al. Rendezvous cannulation technique reduces post-ERCP pancreatitis: a prospective nationwide study of 12 718 ERCP procedures. Am J Gastroenterol, 2013, 108(4): 552-559.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Laparoscopic cholecystectomy plus laparoscopic common bile duct exploration compared with laparoscopic cholecystectomy plus endoscopic retrograde cholangiopancreato-graphy for patients with concomitant cholelithiasis and choledocholithiasis: a meta-analysis

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