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01-08-2019 | Scientific Review

Laparoscopic Transcystic Versus Transductal Common Bile Duct Exploration: A Systematic Review and Meta-analysis

Authors: Shahin Hajibandeh, Shahab Hajibandeh, Diwakar Ryali Sarma, Sankar Balakrishnan, Mokhtar Eltair, Rajnish Mankotia, Misra Budhoo, Yogesh Kumar

Published in: World Journal of Surgery | Issue 8/2019

Abstract

Objective

To evaluate comparative outcomes of laparoscopic transcystic (TC) and transductal (TD) common bile duct (CBD) exploration.

Methods

We systematically searched MEDLINE, EMBASE, CINAHL, CENTRAL, the World Health Organization International Clinical Trials Registry, ClinicalTrials.gov, ISRCTN Register, and bibliographic reference lists. CBD clearance rate, perioperative complications, and biliary complications were defined as the primary outcome parameters. Procedure time, length of hospital stay, conversion to open procedure were the secondary outcomes. Combined overall effect sizes were calculated using random-effects models.

Results

We identified 30 studies reporting a total of 4073 patients comparing outcomes of laparoscopic TC (n = 2176) and TD (N = 1897) CBD exploration. The TC approach was associated with significantly lower overall complications (RD: −0.07, P = 0.001), biliary complications (RD: −0.05, P = 0.0003), and blood loss (MD: −16.20, P = 0.02) compared to TD approach. Moreover, the TC approach significantly reduced the length of hospital stay (MD: −2.62, P < 0.00001) and procedure time (MD: −12.73, P = 0.005). However, there was no significant difference in rate of CBD clearance (RD: 0.00, P = 0.77) and conversion to open procedure (RD: 0.00, P = 0.86) between two groups.

Conclusions

Laparoscopic TC CBD exploration is safe and reduces overall morbidity and biliary complications compared to the TD approach. Moreover, it is associated with significantly shorter length of hospital stay and procedure time. High-quality randomised trials may provide stronger evidence with respect to impact of the cystic duct/CBD diameter, number or size of CBD stones, or cystic duct anatomy on the comparative outcomes of TC and TD approaches.

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Petelin JB (2003) Laparoscopic common bile duct exploration. Surg Endosc 17:1705–1715CrossRefPubMed

Williams EJ, Green J, Beckingham I, Parks R, Martin D, Lombard M (2008) British Society of Gastroenterology. Guidelines on the management of common bile duct stones (CBDS). Gut 57:1004–1021CrossRefPubMed

ASGE standards of Practice Committee, Maple JT, Ben-Menachem T, Anderson MA et al (2010) The role of endoscopy in the evaluation of suspected choledocholithiasis. Gastrointest Endosc 71:1–9CrossRef

Dasari BV, Tan CJ, Gurusamy KS et al (2013) Surgical versus endoscopic treatment of bile duct stones. Cochrane Database Syst Rev 12:CD003327

Alexakis N, Connor S (2012) Meta-analysis of one- vs. two-stage laparoscopic/endoscopic management of common bile duct stones. HPB (Oxford) 14:254–259CrossRef

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 18:3156–3166CrossRefPubMedPubMedCentral

Puhalla H, Flint N, O’Rourke N (2015) Surgery for common bile duct stones—a lost surgical skill; still worthwhile in the minimally invasive century? Langenbecks Arch Surg 400:119–127CrossRefPubMed

Reinders JS, Gouma DJ, Ubbink DT, van Ramshorst B, Boerma D (2014) Transcystic or transductal stone extraction during single-stage treatment of choledochocystolithiasis: a systematic review. World J Surg 38:2403–2411. https://doi.org/10.1007/s00268-014-2537-8 CrossRefPubMed

Pang L, Zhang Y, Wang Y, Kong J (2018) Transcystic versus traditional laparoscopic common bile duct exploration: its advantages and a meta-analysis. Surg Endosc 32(11):4363–4376CrossRefPubMed

10.

Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700CrossRefPubMedPubMedCentral

11.

Slim K, Haugh M, Fagniez P-L, Pezet D, Chipponi J (2000) Ten-year audit of randomised trials in digestive surgery from Europe. Br J Surg 87:1585–1586CrossRefPubMed

12.

Higgins JP, Altman DG, editors. Chapter 8: Assessing risk of bias in included studies. In: Higgins JP, Green S, editors. Cochrane handbook for systematic reviews of interventions. Version 5.0.1 [updated September 2008]. http://hiv.cochrane.org/sites/hiv. cochrane.org/files/uploads/Ch08_Bias.pdf. Accessed Oct 27, 2018

13.

Martin IJ, Bailey IS, Rhodes M, O’Rourke N, Nathanson L, Fielding G (1998) Towards T-tube free laparoscopic bile duct exploration: a methodologic evolution during 300 consecutive procedures. Ann Surg 228:29–34CrossRefPubMedPubMedCentral

14.

Rhodes M, Sussman L, Cohen L, Lewis MP (1998) Randomised trial of laparoscopic exploration of common bile duct versus postoperative endoscopic retrograde cholangiography for common bile duct stones. Lancet 351:159–161CrossRefPubMed

15.

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 13:952–957CrossRefPubMed

16.

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 57:467–474PubMed

17.

Tokumura H, Umezawa A, Cao H, Sakamoto N, Imaoka Y, Ouchi A, Yamamoto K (2002) Laparoscopic management of common bile duct stones: transcystic approach and choledochotomy. J Hepatobiliary Pancreat Surg 9:206–212CrossRefPubMed

18.

Waage A, StroÈmberg C, Leijonmarck CE, Arvidsson D (2003) Long-term results from laparoscopic common bile duct exploration. Surg Endosc 17:1181–1185CrossRefPubMed

19.

Paganini AM, Guerrieri M, Sarnari J, De Sanctis A, D’Ambrosio G, Lezoche G, Perretta S, Lezoche E (2007) Thirteen years’ experience with laparoscopic transcystic common bile duct exploration for stones. Effectiveness and long-term results. Surg Endosc 21(1):34–40CrossRefPubMed

20.

Topal B, Aerts R, Penninckx F (2007) Laparoscopic common bile duct stone clearance with flexible choledochoscopy. Surg Endosc 21(12):2317–2321CrossRefPubMed

21.

Chen X, Ding Y, Wang W, Zhang A, Wang P, Wang B (2007) The comparative study on two types of laparoscopic common bile duct exploration. J Clin Surg 15:520–521

22.

Jameel M, Darmas B, Baker AL (2008) Trend towards primary closure following laparoscopic exploration of the common bile duct. Ann R Coll Surg Engl 90(1):29–35CrossRefPubMedPubMedCentral

23.

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 19:713–720CrossRefPubMed

24.

ElGeidie AA, ElShobary MM, Naeem YM (2011) Laparoscopic exploration versus intraoperative endoscopic sphincterotomy for common bile duct stones: a prospective randomized trial. Dig Surg 28(5–6):424–431CrossRefPubMed

25.

Grubnik VV, Tkachenko AI, Ilyashenko VV, Vorotyntseva KO (2012) Laparoscopic common bile duct exploration versus open surgery: comparative prospective randomized trial. Surg Endosc 26(8):2165–2171CrossRefPubMed

26.

Chen XM, Zhang Y, Cai HH, Sun DL, Liu SY, Duan YF, Yang C, Jiang Y, Wu HR (2013) Transcystic approach with microincision of the cystic duct and its confluence part in laparoscopic common bile duct exploration. J Laparoendosc Adv Surg Tech A 23(12):977–981CrossRefPubMed

27.

Zhou YP, Guo ZJ, Dai T, Chen B (2013) Curative effects of laparoscopic transcystic common bile duct exploration. Chin J Clin Med 20(3):294–296

28.

Tao Y, Chen D, Li H, Zhu A, Xing J (2013) Comparison of transcyst with trarsduct incision in laparoscopic choledochotomy with primary ductal closure. Chin J Min Inv Surg 13:869–872

29.

Wang C, Gu H, He JY (2014) A comparative study of laparoscopic transcystic common bile duct exploration with laparoscopic transcystic common bile exploration for secondary extrahepatic bile duct stones. J Xinjiang Med Univ 37(10):1318–1320

30.

Tulati T (2014) Effects of laparoscopic transcystic common bile duct exploration. Front Med. 6:21–22

31.

Poh B, Cashin P, Bowers K, Ackermann T, Tay YK, Dhir A, Croagh D (2014) Management of choledocholithiasis in an emergency cohort undergoing laparoscopic cholecystectomy: a single-centre experience. HPB (Oxford) 16(7):629–634CrossRef

32.

Wu S, Zhan S, Qiu H (2014) The clinical study of treatment common bile duct stones by laparoscopic cystic duct approach. Anhui Med J 35:685–686

33.

Abdelrahman T, Ward A, Nutt MR, Boyce TH, Rasheed AM (2014) A retrospective comparative study of the transcystic and transcholedochal approach to laparoscopic bile duct exploration. J Am Coll Surg 219(4):22CrossRef

34.

Zhang WJ, Xu GF, Huang Q, Luo KL, Dong ZT, Li JM, Wu GZ, Guan WX (2015) Treatment of gallbladder stone with common bile duct stones in the laparoscopic era. BMC Surg 15:7CrossRefPubMedPubMedCentral

35.

Hongjun H, Yong J, Baoqiang W (2015) Laparoscopic common bile duct exploration: choledochotomy versus transcystic approach? Surg Laparosc Endosc Percutan Tech 25(3):218–222CrossRefPubMed

36.

Aawsaj Y, Light D, Horgan L (2016) Laparoscopic common bile duct exploration: 15-year experience in a district general hospital. Surg Endosc 30(6):2563–2566CrossRefPubMed

37.

Huang S (2015) Efficacy comparison of laparoscopic common bile duct through the cystic duct lithotomy and choledocholithotomy surgery. Mod Pract Med 27:213–214

38.

Li P, Wu Y, Huang ZY (2016) Clinical analysis of laparoscopic choledocholithotomy by choledochal duct exploration. Mod Diagn Treat 27(13):2453–2454

39.

Han MM, Bao Z, Yang ZJ (2016) Analysis of clinical efficacy of LTCBDE in patients with secondary extrahepatic bile duct stones. J Pract Med 32(12):1991–1993

40.

Liu Y, Han W, Gong PM, Shi W (2016) Clinical analysis of laparoscopic surgery for secondary bile duct stones via cystic duct. China J Endosc 22(4):31–33

41.

Sun H (2017) The clinical efficacy of LTCBDE in the treatment of secondary extrahepatic bile duct stones. J Clin Med 4(11):2050–2051

42.

Al-Temimi MH, Rangarajan S, Chandrasekaran B, Kim EG, Trujillo CN, Mousa AF, Santos DA, Johna SD (2018) Predictors of failed transcystic laparoscopic common bile duct exploration: analysis of multicenter integrated health system database. J Laparoendosc Adv Surg Tech A. 29(3):360–365CrossRefPubMed

43.

Wills VL, Gibson K, Karihaloot C, Jorgensen JO (2002) Complications of biliary T-tubes after choledochotomy. ANZ J Surg 72(3):177–180CrossRefPubMed

44.

Ha JP, Tang CN, Siu WT, Chau CH, Li MK (2004) Primary closure versus T-tube drainage after laparoscopic choledochotomy for common bile duct stones. Hepatogastroenterology 51(60):1605–1608PubMed

45.

Ricci C, Pagano N, Taffurelli G, Pacilio CA, Migliori M, Bazzoli F, Casadei R, Minni F (2018) Comparison of efficacy and safety of 4 combinations of laparoscopic and intraoperative techniques for management of gallstone disease with biliary duct calculi: a systematic review and network meta-analysis. JAMA Surg 153(7):e181167CrossRefPubMedPubMedCentral

Title: Laparoscopic Transcystic Versus Transductal Common Bile Duct Exploration: A Systematic Review and Meta-analysis
Authors: Shahin Hajibandeh
Shahab Hajibandeh
Diwakar Ryali Sarma
Sankar Balakrishnan
Mokhtar Eltair
Rajnish Mankotia
Misra Budhoo
Yogesh Kumar
Publication date: 01-08-2019
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 8/2019
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-019-05005-y

At a glance: The STEP trials

Springer Medicine

Laparoscopic Transcystic Versus Transductal Common Bile Duct Exploration: A Systematic Review and Meta-analysis

Abstract

Objective

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

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