LAPAROSCOPIC COMMON BILE DUCT EXPLORATION VERSUS PRE- OR INTRAOPERATIVE ENDOSCOPIC TREATMENT FOR CHOLEDOCHOLITHIASIS A SYSTEMATIC REVIEW AND META-ANALYSIS

Victor Hugo B. Custódio, Amanda G. Oliveira, Fábio A. Gonçalves - Jr, João Pedro A. Carani, Isabella B. Aguiar, Antonio José M. Cataneo and César T. Spadella*

ABSTRACT

Aim: This systematic review aimed to compare laparoscopic common bile duct exploration (LCBDE) with pre- or intraoperative endoscopic retrograde cholangiopancreatography with sphincterotomy (ERCP/S), both associated with laparoscopic cholecystectomy (LC), for the treatment of choledocholithiasis. Methods: Only RCTs were included in this review, which were searched in major literature databases from 1970 to 2021. Results: Meta-analysis of 14 primary studies with 2214 patients showed that successful CBD stone clearance was higher in LC+LCBDE than in pre-ERCP/S+LC (91.3% vs. 90.1%) but lower than in intra-ERCP/S+LC (88.5% vs. 91.6%). However, there were no significant differences among the groups. Except for conversion to open surgery, the laparoscopic arm had lower rates of retained stones, failure of procedure, cross over to other procedure, total morbidity, and mortality compared to pre-ERCP/S+LC. On the other hand, the rates of all those secondary outcomes were lower in intra-ERCP/S+LC than in LC+LCBDE, but there were no significant differences among the groups. Pancreatitis episodes were significantly more frequent in both endoscopic groups, while bile leakage was higher in LC+LCBDE. Overall, operative time was significantly higher in LC+LCBDE than in pre-ERCP/S+LC but lower than in the intra-ERCP/S+LC group. The length of hospital stay was significantly shorter in the laparoscopic arm than in the pre-ERCP/S+LC group but longer in the intra-ERCP/S+LC group. Conclusion: This systematic review shows that either LC+LCBDE or pre- and intra-ERCP/S+LC are safe and highly effective in removing CBD stones. However, the results suggest that single-step interventions are better for appropriate patients and health services.

Keywords: Laparoscopic Common Bile Duct Exploration. Endoscopic Retrograde Cholangiopancreatography/Sphyncterotomy. Laparoscopic Cholecystectomy. Cholelithiasis. Choledocholithiasis. Systematic Review and Meta-Analysis.