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

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.

Keywords: Cholecystocholedocholithiasis; Endoscopic retrograde cholangiopancreatography; Laparoendoscopic rendezvous; Laparoscopic cholecystectomy.