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Surgical Endoscopy
Published in: Surgical Endoscopy 9/2020

01-09-2020 | Cholecystectomy | New Technology

Laparoendoscopic rendezvous versus ERCP followed by laparoscopic cholecystectomy in the management of cholecystocholedocholithiasis: a systemic review and meta-analysis

Authors: Yan Lin, Yan Su, Jun Yan, Xun Li

Published in: Surgical Endoscopy | Issue 9/2020

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Abstract

Background

The ideal management for patients with cholecystocholedocholithiasis is still controversial. Laparoendoscopic rendezvous (LERV), combined with laparoscopy and endoscopy, is a novel and attractive technique. The aim of this research was to compare LERV with traditional two-stage management, preoperative ERCP and laparoscopic cholecystectomy (ERCP + LC), for treating patients with cholecystocholedocholithiasis.

Method

Four databases, the Cochrane Library, PubMed, Embase, and Medline, all updated to through September 2019, were searched to identify comparative studies on LERV versus ERCP + LC for treating cholecystocholedocholithiasis. Total operative time, successful common bile duct (CBD) stone clearance, postoperative morbidity, conversion to other procedures, and length of hospital stay were evaluated. Pooled data were measured by odds ratios (ORs) and mean difference (MD) with 95% confidence intervals (CIs).

Results

Eight studies with a total of 1061 patients were included in this meta-analysis, including 542 patients who received LERV and 519 patients who received ERCP + LC. There was no significant difference between the two groups regarding successful CBD stone clearance (OR 2.20, P = 0.10), postoperative bleeding (OR 0.67, P = 0.37), postoperative cholangitis (OR 0.66, P = 0.53), postoperative bile leak (OR 0.87, P = 0.81), or conversion to other procedures (OR 0.75, P = 0.62). The total operative time was longer in the LERV group (MD = 44.93, P < 0.00001), while LERV was associated with less postoperative pancreatitis than the two-stage management group (OR 0.26, P = 0.0003). The incidence of overall morbidity was lower in the LERV group than in the two-stage management group (OR 0.41, P < 0.0001), and the LERV group had a shorter hospital stay (MD = − 3.52, P < 0.00001).

Conclusion

LERV is equivalent to traditional two-stage procedures in terms of CBD stone clearance and conversion, with less pancreatitis, lower overall morbidity, and shorter hospital stay but longer operation time. More clinical trials are needed to determine the best treatment for patients in different conditions.
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Metadata
Title
Laparoendoscopic rendezvous versus ERCP followed by laparoscopic cholecystectomy in the management of cholecystocholedocholithiasis: a systemic review and meta-analysis
Authors
Yan Lin
Yan Su
Jun Yan
Xun Li
Publication date
01-09-2020
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 9/2020
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-020-07698-y

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