Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Surgical Endoscopy
Published in: Surgical Endoscopy 9/2018

01-09-2018 | Review

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

Authors: Anand Narayan Singh, Ragini Kilambi

Published in: Surgical Endoscopy | Issue 9/2018

Login to get access

Abstract

Background

The ideal management of common bile duct (CBD) stones associated with gall stones is a matter of debate. We planned a meta-analysis of randomized trials comparing single-stage laparoscopic CBD exploration and cholecystectomy (LCBDE) with two-stage preoperative endoscopic stone extraction followed by cholecystectomy (ERCP + LC).

Methods

We searched the Pubmed/Medline, Web of science, Science citation index, Google scholar and Cochrane Central Register of Controlled trials electronic databases till June 2017 for all English language randomized trials comparing the two approaches. Statistical analysis was performed using Review Manager (RevMan) [Computer program], Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014 and results were expressed as odds ratio for dichotomous variables and mean difference for continuous. p value ≤ 0.05 was considered significant. Trial sequential analysis (TSA) was performed using TSA version 0.9.5.5 (Copenhagen: The Copenhagen Trial Unit, Centre for Clinical Intervention Research, 2016). PROSPERO trial registration number is CRD42017074673.

Results

A total of 11 trials were included in the analysis, with a total of 1513 patients (751-LCBDE; 762-ERCP + LC). LCBDE was found to have significantly lower rates of technical failure [OR 0.59, 95% CI (0.38, 0.93), p = 0.02] and shorter hospital stay [MD − 1.63, 95% CI (− 3.23, − 0.03), p = 0.05]. There was no significant difference in mortality [OR 0.37, 95% CI (0.09, 1.51), p = 0.17], morbidity [OR 0.97, 95% CI (0.70, 1.33), p = 0.84], cost [MD − 379.13, 95% CI (− 784.80, 111.2), p = 0.13] or recurrent/retained stones [OR 1.01, 95% CI (0.38, 2.73), p = 0.98]. TSA showed that although the Z-curve crossed the boundaries of conventional significance, the estimated information size is yet to be achieved.

Conclusions

Single-stage LCBDE is superior to ERCP + LC in terms of technical success and shorter hospital stay in good-risk patients with gallstones and CBD stones, where expertise, operative time and instruments are available.
Appendix
Available only for authorised users
Literature
1.
Neuhaus H, Feussner H, Ungeheuer A, Hoffmann W, Siewert JR, Classen M (1992) Prospective evaluation of the use of endoscopic retrograde cholangiography prior to laparoscopic cholecystectomy. Endoscopy 24(9):745–749CrossRefPubMed
2.
Wenckert A, Robertson B (1966) The natural course of gallstone disease: eleven-year review of 781 nonoperated cases. Gastroenterology 50(3):376–381PubMed
3.
Bingener J, Schwesinger WH (2006) Management of common bile duct stones in a rural area of the United States: results of a survey. Surg Endosc 20(4):577–579CrossRefPubMed
4.
Vannijvel M, Lesurtel M, Bouckaert W, Houben B, Knol J, Vangertruyden G et al (2016) A survey of European-African surgeons’ management of common bile duct stones. HPB 18(12):959–964CrossRefPubMedPubMedCentral
5.
Wandling MW, Hungness ES, Pavey ES, Stulberg JJ, Schwab B, Yang AD et al (2016) Nationwide assessment of trends in choledocholithiasis management in the United States from 1998 to 2013. JAMA Surg 151(12):1125–1130CrossRefPubMed
6.
7.
Dasari BVM, Tan CJ, Gurusamy KS, Martin DJ, Kirk G, McKie L et al (2013) Surgical versus endoscopic treatment of bile duct stones. Cochrane Database Syst Rev 12(12):CD003327
8.
Prasson P, Bai X, Zhang Q, Liang T (2016) 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(8):3582–3590CrossRefPubMed
9.
Lu J, Cheng Y, Xiong X-Z, Lin Y-X, Wu S-J, Cheng N-S (2012) Two-stage vs single-stage management for concomitant gallstones and common bile duct stones. World J Gastroenterol 18(24):3156–3166CrossRefPubMedPubMedCentral
10.
Nagaraja V, Eslick GD, Cox MR (2014) Systematic review and meta-analysis of minimally invasive techniques for the management of cholecysto-choledocholithiasis. J Hepato-Biliary-Pancreat Sci 21(12):896–901CrossRef
11.
Zhu H-Y, Xu M, Shen H-J, Yang C, Li F, Li K-W et al (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):584–593CrossRefPubMed
12.
Deeks J, Higgins J, Altman D (2011) Chapter 9: Analysing data and undertaking meta-analyses. In: Higgins JPT, Green S (eds) Cochrane Handbook for Systematic Reviews of Interventions Version 510 (updated March 2011) The Cochrane Collaboration. http://​www.​cochrane-handbook.​org
13.
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):1986–1989CrossRefPubMed
14.
Bansal VK, Misra MC, Rajan K, Kilambi R, Kumar S, Krishna A et al (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):875–885CrossRefPubMed
15.
Cuschieri A, Lezoche E, Morino M, Croce E, Lacy A, Toouli J et al (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):952–957CrossRefPubMed
16.
González JEB, Torres Peña R, Ruiz Torres J, Martínez Alfonso M, Brizuela Quintanilla R, Morera Pérez M (2016) Endoscopic versus laparoscopic treatment for choledocholithiasis: a prospective randomized controlled trial. Endosc Int Open 4(11):E1188–E1193CrossRef
17.
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 Off J Soc Surg Aliment Tract 18(5):947–951CrossRef
18.
19.
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):457–463CrossRefPubMed
20.
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 A 19(6):713–720CrossRefPubMed
21.
Rogers SJ, Cello JP, Horn JK, Siperstein AE, Schecter WP, Campbell AR et al (2010) Prospective randomized trial of LC + LCBDE vs ERCP/S + LC for common bile duct stone disease. Arch Surg 145(1):28–33CrossRefPubMed
22.
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 Chir 57(4):467–474PubMed
23.
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):5615–5620CrossRefPubMedPubMedCentral
24.
Williams E, Beckingham I, El Sayed G, Gurusamy K, Sturgess R, Webster G et al (2017) Updated guideline on the management of common bile duct stones (CBDS). Gut 66(5):765–782CrossRefPubMed
25.
Keeling NJ, Menzies D, Motson RW (1999) Laparoscopic exploration of the common bile duct: beyond the learning curve. Surg Endosc 13(2):109–112CrossRefPubMed
26.
Baucom RB, Feurer ID, Shelton JS, Kummerow K, Holzman MD, Poulose BK (2016) Surgeons, ERCP, and laparoscopic common bile duct exploration: do we need a standard approach for common bile duct stones? Surg Endosc 30(2):414–423CrossRefPubMed
27.
Christensen M, Matzen P, Schulze S, Rosenberg J (2004) Complications of ERCP: a prospective study. Gastrointest Endosc 60(5):721–731CrossRefPubMed
28.
Donkervoort SC, van Ruler O, Dijksman LM, van Geloven AA, Pierik EG (2010) Identification of risk factors for an unfavorable laparoscopic cholecystectomy course after endoscopic retrograde cholangiography in the treatment of choledocholithiasis. Surg Endosc 24(4):798–804CrossRefPubMed
29.
Loperfido S, Angelini G, Benedetti G, Chilovi F, Costan F, De Berardinis F et al (1998) Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study. Gastrointest Endosc 48(1):1–10CrossRefPubMed
30.
Thompson MH, Tranter SE (2002) All-comers policy for laparoscopic exploration of the common bile duct. Br J Surg 89(12):1608–1612CrossRefPubMed
31.
Wei Q, Wang J-G, Li L-B, Li J-D (2003) Management of choledocholithiasis: Comparison between laparoscopic common bile duct exploration and intraoperative endoscopic sphincterotomy. World J Gastroenterol WJG 9(12):2856–2858CrossRefPubMed
32.
Tang CN, Tsui KK, Ha JPY, Siu WT, Li MKW (2006) Laparoscopic exploration of the common bile duct: 10-year experience of 174 patients from a single centre. Hong Kong Med J Xianggang Yi Xue Za Zhi 12(3):191–196PubMed
33.
Ebner S, Rechner J, Beller S, Erhart K, Riegler FM, Szinicz G (2004) Laparoscopic management of common bile duct stones. Surg Endosc 18(5):762–765CrossRefPubMed
34.
Li MKW, Tang CN, Lai ECH (2011) Managing concomitant gallbladder stones and common bile duct stones in the laparoscopic era: a systematic review. Asian J Endosc Surg 4(2):53–58CrossRefPubMed
35.
Costi R, DiMauro D, Mazzeo A, Boselli AS, Contini S, Violi V et al (2007) Routine laparoscopic cholecystectomy after endoscopic sphincterotomy for choledocholithiasis in octogenarians: is it worth the risk? Surg Endosc 21(1):41–47CrossRefPubMed
36.
Pring CM, Skelding-Millar L, Goodall RJR (2005) Expectant treatment or cholecystectomy after endoscopic retrograde cholangiopancreatography for choledocholithiasis in patients over 80 years old? Surg Endosc 19(3):357–360CrossRefPubMed
37.
38.
Topal B, Vromman K, Aerts R, Verslype C, Van Steenbergen W, Penninckx F (2010) Hospital cost categories of one-stage versus two-stage management of common bile duct stones. Surg Endosc 24(2):413–416CrossRefPubMed
39.
Heili MJ, Wintz NK, Fowler DL (1999) Choledocholithiasis: endoscopic versus laparoscopic management. Am Surg 65(2):135–138PubMed
40.
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):79CrossRefPubMedPubMedCentral
Metadata
Title
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
Authors
Anand Narayan Singh
Ragini Kilambi
Publication date
01-09-2018
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 9/2018
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-018-6170-8

Other articles of this Issue 9/2018

Surgical Endoscopy 9/2018 Go to the issue

OriginalPaper

Characteristics of the parathyroid gland in endoscopic thyroidectomy with the application of an image enhancement system

OriginalPaper

Optimal time of resuming anticoagulant after endoscopic sphincterotomy in patients at risk for thromboembolism: a retrospective cohort study

Dynamic Manuscript

Technique, safety, and feasibility of EUS-guided radiofrequency ablation in unresectable pancreatic cancer

OriginalPaper

Laparoscopic surgery for perforated peptic ulcer: an English national population-based cohort study

OriginalPaper

Endoscopy versus radiology in post-procedural monitoring after peroral endoscopic myotomy (POEM)

OriginalPaper

Laparoscopic distal pancreatectomy: which factors are related to open conversion? Lessons learned from 68 consecutive procedures in a high-volume pancreatic center