Caining Lei1,2,3, Tingting Lu3,4,5, Wenwen Yang2,6, Man Yang7, Hongwei Tian2,8, Shaoming Song2,6, Shiyi Gong2, Jia Yang2, Wenjie Jiang9, Kehu Yang10,11, Tiankang Guo12,13,14. 1. The First Clinical Medicine College, Gansu University of Chinese Medicine, Lanzhou, 730000, China. 2. Department of General Surgery, Gansu Provincial Hospital, Lanzhou, 730000, China. 3. Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China. 4. Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China. 5. Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, 730000, China. 6. The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730000, China. 7. The Affiliated Cancer Hosptial School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610000, China. 8. Key Laboratory of Surgical Tumor Molecular Diagnosis and Precision Therapy in Gansu Province, Lanzhou, 730000, China. 9. Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, 730000, China. 10. Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China. kehuyangebm2006@126.com. 11. Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China. kehuyangebm2006@126.com. 12. The First Clinical Medicine College, Gansu University of Chinese Medicine, Lanzhou, 730000, China. tiankangguo2019@163.com. 13. Department of General Surgery, Gansu Provincial Hospital, Lanzhou, 730000, China. tiankangguo2019@163.com. 14. Key Laboratory of Surgical Tumor Molecular Diagnosis and Precision Therapy in Gansu Province, Lanzhou, 730000, China. tiankangguo2019@163.com.
Abstract
BACKGROUND: This study aimed to compare the efficacy and safety of laparoscopic cholecystectomy combined with intraoperative endoscopic retrograde cholangiopancreatography (LC-IntraERCP) and laparoscopic cholecystectomy combined with laparoscopic common bile duct exploration (LC-LCBDE) to determine which one-stage therapeutic strategy provides better outcomes for patients with gallstones and common bile duct stones. METHODS: Cochrane Library, EMBASE, PubMed, and Web of Science databases were searched to identify eligible articles from the database inception to September 2020. The revised Cochrane risk of bias tools for randomized trials (RoB-2) and non-randomized interventions (ROBINS-I) was used to assess the quality of the included studies. The overall quality of evidence was assessed through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. The primary outcomes consisted of surgical success, retained stones, and overall postoperative complications, while secondary outcomes included postoperative bleeding, postoperative pancreatitis, postoperative bile leakage, conversion to laparotomy, and operative time. RESULTS: Eight studies (four RCTs and four Non-RCTs with high quality) with 2948 patients were included. No significant difference was seen between the two groups regarding surgical success, overall postoperative complications, conversion to laparotomy, and operative time. The meta-analysis demonstrated that in the LC-IntraERCP group, the rate of retained stones (OR 0.51, 95% CI 0.28-0.91) and postoperative bile leakage were lower (OR 0.25, 95% CI 0.09-0.69), while in the LC-LCBDE group, postoperative bleeding (OR 5.24, 95% CI 1.65-16.65) and postoperative pancreatitis (OR 4.80, 95% CI 2.35-9.78) decreased. CONCLUSIONS: LC-IntraERCP and LC-LCBDE exhibited similar efficacies when surgical success rate, overall postoperative complications, conversion to laparotomy, and operative time were compared. However, LC-IntraERCP is probably to be more effective in terms of lowering the rate of retained stones.
BACKGROUND: This study aimed to compare the efficacy and safety of laparoscopic cholecystectomy combined with intraoperative endoscopic retrograde cholangiopancreatography (LC-IntraERCP) and laparoscopic cholecystectomy combined with laparoscopic common bile duct exploration (LC-LCBDE) to determine which one-stage therapeutic strategy provides better outcomes for patients with gallstones and common bile duct stones. METHODS: Cochrane Library, EMBASE, PubMed, and Web of Science databases were searched to identify eligible articles from the database inception to September 2020. The revised Cochrane risk of bias tools for randomized trials (RoB-2) and non-randomized interventions (ROBINS-I) was used to assess the quality of the included studies. The overall quality of evidence was assessed through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. The primary outcomes consisted of surgical success, retained stones, and overall postoperative complications, while secondary outcomes included postoperative bleeding, postoperative pancreatitis, postoperative bile leakage, conversion to laparotomy, and operative time. RESULTS: Eight studies (four RCTs and four Non-RCTs with high quality) with 2948 patients were included. No significant difference was seen between the two groups regarding surgical success, overall postoperative complications, conversion to laparotomy, and operative time. The meta-analysis demonstrated that in the LC-IntraERCP group, the rate of retained stones (OR 0.51, 95% CI 0.28-0.91) and postoperative bile leakage were lower (OR 0.25, 95% CI 0.09-0.69), while in the LC-LCBDE group, postoperative bleeding (OR 5.24, 95% CI 1.65-16.65) and postoperative pancreatitis (OR 4.80, 95% CI 2.35-9.78) decreased. CONCLUSIONS: LC-IntraERCP and LC-LCBDE exhibited similar efficacies when surgical success rate, overall postoperative complications, conversion to laparotomy, and operative time were compared. However, LC-IntraERCP is probably to be more effective in terms of lowering the rate of retained stones.
Keywords:
Common bile duct stones; Endoscopic retrograde cholangiopancreatography; Gallstones; Laparoscopic cholecystectomy; Laparoscopic common bile duct exploration
Authors: Gianpiero Manes; Gregorios Paspatis; Lars Aabakken; Andrea Anderloni; Marianna Arvanitakis; Philippe Ah-Soune; Marc Barthet; Dirk Domagk; Jean-Marc Dumonceau; Jean-Francois Gigot; Istvan Hritz; George Karamanolis; Andrea Laghi; Alberto Mariani; Konstantina Paraskeva; Jürgen Pohl; Thierry Ponchon; Fredrik Swahn; Rinze W F Ter Steege; Andrea Tringali; Antonios Vezakis; Earl J Williams; Jeanin E van Hooft Journal: Endoscopy Date: 2019-04-03 Impact factor: 10.093