scholarly journals O-EGS03 Laparoscopic surgery versus Endoscopy in the management Common Bile Duct Stones: systematic review and Meta-analysis

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Hafs Elhag ◽  
Omar Eltayeb
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Hospital Stay ◽  
Meta Analysis ◽  
Acute Cholangitis ◽  
Surgical Site Infections ◽  
Common Bile Duct Stones ◽  
Common Bile Duct Exploration ◽  
Duration Of Hospital Stay ◽  
Cbd Stones

Abstract Background With the advancement in minimally invasive surgery, a 1 stage Laparoscopic Common Bile Duct Exploration (LCBDE) followed by Laparoscopic Cholecystectomy (LC) is a great alternative to removing the gallbladder and CBD stones provided the surgeon possesses the necessary skills. The current guidelines for managing CBD stones is the 2 stage approach, Endoscopic Retrograde Cholangiopancreatography (ERCP) followed by (LC). The objective of this study is to assess whether LCBDE+LC should be the gold standard in managing CBD stones by comparing the clearance rate of common bile duct stones, morbidity, mortality, and the duration of hospital stay with ERCP+LC. Methods This is a systematic review with a meta-analysis that included RCTs of patients who were treated by the LCBDE/LC versus ERCP+LC. The PRISMA guidelines for reporting systemic reviews were followed. RCTs were collected by 2 authors Independently from Cochrane Central Register of Controlled Trials, Medline and Embase. Statistical analysis was carried out by a computer application called Review Manager using the Mantel–Haenszel method, the results were then plotted on a Forest Plot diagram and the 2 groups were then compared. Results 849 patients from 7 RCTs were included in the study, 426 patients in the ERCP+LC arm and 423 in the LCBDE/LC arm. According to the Meta-analysis, Laparoscopic Common Bile Duct Exploration with Cholecystectomy was significantly superior to ERCP + LC in terms of successful Clearance of CBD stone, mortality rate, and Acute Pancreatitis. but had significantly higher rates in biliary leakages. There were no significant differences in Surgical Site Infections, Haemorrhages, Acute Cholangitis, Perforations, or duration of hospital stay between the two arms. Conclusions The current evidence suggests that LCBDE/LC is superior in successful CBD stone clearance, mortality, and acute pancreatitis. However, further RCTs will be needed to assess overall Morbidity, surgical site infections, Haemorrhages, Acute Cholangitis, perforations, or duration of hospital stay. The current guidelines must be reviewed to consider LCBDE/LC as the gold standard in managing patients with CBD stones.

scholarly journals Laparoscopic CBD Exploration (LCBDE) a better and safe option for large CBD stones

2021 ◽  
Vol 15 (6) ◽  
pp. 1321-1323
Author(s):  
I. Sadiq ◽  
A. Malik ◽  
J. K. Lodhi ◽  
S. T. Bukhari ◽  
R. Maqbool ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Bile Leak ◽  
Common Bile Duct Stones ◽  
Common Bile Duct Exploration ◽  
Open Approach ◽  
Cbd Stones ◽  
Duration Of Surgery ◽  
Laparoscopic Cbd Exploration ◽  
Cbd Exploration

Background: Conventionally, common bile duct stones (CBDS) are removed with help of ERCP. However, if CBDS are larger than 10 mm, then the ERCP failure rate to retrieve CBDS becomes high. In that case, open or laparoscopic common bile duct exploration (LCBDE) is other alternative. In this era of minimally invasive surgery, laparoscopic CBD exploration (LCBDE) seems to be a better option than open approach, but in our set up the safety of LCBDE is questioned. Aim: To see the conversion rate as well as complications associated with LCBDE. Material & Methods: Methods: This is a retrospective analysis of data of patients who underwent Laparoscopic Common Bile Duct Exploration (LCBDE) for large CBD stones at Fatima Memorial Hospital Lahore. Results: Since 2012, 29 patients of large (≥10 mm) CBD stones were included in this study. Among them 20(69.9%) were females and 9(31.01%) were males. The mean CBD stone size was 13 mm. Stones were extracted transcystically in 4 case and Transcholedochal stone extraction was done in 25 cases. The average duration of surgery was 130 minutes, but all cases were completed successfully without converting to open approach. There was minor bile leak in 3 patients which was managed successfully without any further intervention. No other complication was observed with LCBDE and even no retained stone was reported. Conclusion: Laparoscopic CBD exploration is safe and effective method of dealing CBD stones especially of large size when the chances of ERCP failure to retrieve stones are high. Keywords: Laparoscopy, ERCP, common bile duct,

scholarly journals Meta-analysis of the diagnostic accuracy of laparoscopic ultrasonography and intraoperative cholangiography in detection of common bile duct stones

2016 ◽  
Vol 98 (04) ◽  
pp. 244-249 ◽  
Author(s):  
KN Jamal ◽  
H Smith ◽  
K Ratnasingham ◽  
MR Siddiqui ◽  
G McLachlan ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Sensitivity And Specificity ◽  
Random Effects ◽  
Meta Analysis ◽  
Common Bile Duct Stones ◽  
Intraoperative Cholangiography ◽  
Attractive Alternative ◽  
Laparoscopic Ultrasonography ◽  
Cbd Stones

Introduction During laparoscopic cholecystectomy, intraoperative cholangiography (IOC) is currently regarded as the gold standard in the detection of choledocholithiasis. Laparoscopic ultrasonography (LUS) is an attractive alternative with several potential advantages. Methods A systematic review was undertaken of the published literature comparing LUS with IOC in the assessment of common bile duct (CBD) stones. Results Twenty-one comparative studies were analysed. There were 4,566 patients in the IOC group and 5,044 in the LUS group. The combined sensitivity and specificity of IOC in the detection of CBD stones were 0.87 (95% confidence interval [CI]: 0.83–0.89) and 0.98 (95% CI: 0.98–0.98) respectively with a pooled area under the curve (AUC) of 0.985 and a diagnostic odds ratio (OR) of 260.65 (95% CI: 160.44–423.45). This compares with a sensitivity and specificity for LUS of 0.90 (95% CI: 0.87–0.92) and 0.99 (95% CI: 0.99–0.99) respectively with a pooled AUC of 0.982 and a diagnostic OR of 765.15 (95% CI: 450.78–1,298.76). LUS appeared to be more successful in terms of coming to a clinical decision regarding CBD stones than IOC (random effects, risk ratio: 0.95, 95% CI: 0.93–0.98, df=20, z=-3.7, p<0.005). Furthermore, LUS took less time (random effects, standardised mean difference: 0.95, 95% CI: 0.93–0.98, df=20, z=-3.7, p<0.005). Conclusions LUS is comparable with IOC in the detection of CBD stones. The main advantages of LUS are that it does not involve ionising radiation, is quicker to perform, has a lower failure rate and can be repeated during the procedure as required.

Laparoscopic Exploration of the Common Bile Duct: A Systematic Review of the Published Evidence Over the Last 10 Years

2020 ◽  
pp. 000313482094952
Author(s):  
Bertram Marks ◽  
Ahmad Al Samaraee
Keyword(s):  
Systematic Review ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Hospital Stay ◽  
Open Surgery ◽  
Bile Leak ◽  
Common Bile Duct Exploration ◽  
Duration Of Hospital Stay ◽  
Published Evidence ◽  
The Common

Introduction Endoscopic and open surgical interventions are widely implemented as the standard practice in common bile duct exploration. However, the laparoscopic approach has been also reported to have comparative/superior outcomes in this concept. This has created an ongoing debate about the ideal approach to adopt in practice. Methods A systematic review of the published evidence over the last decade that has looked into the outcomes of laparoscopic exploration of the common bile duct through transductal and transcystic approaches. Results Our systematic review included 36 relevant papers. The majority were based on nonrandomized protocols conducted in single centers with high expertise. The data analysis showed that laparoscopic common bile duct exploration through both approaches was successful in more than 84% of the patients, with an average length of hospital stay of 5.6 days. Conversion to open surgery was reported in 5%-8% of the patients, and the bile leak rates from the more recent studies was 0%-12%, with mortality figures of 0%-1.3%. The outcomes were statistically in favor of the transcystic route when compared to the transductal route from the viewpoints of bile leak rates, mean operative time, duration of hospital stay and morbidity. Conclusion In experienced hands, both laparoscopic approaches in common bile duct exploration are safe in patients who are clinically fit to have this intervention. It is associated with a statistically significant lower overall morbidity and shorter duration of hospital stay when compared to open surgery. Relevant up-to-date high-quality randomized trials are unavailable.

Comparable Safety of ERCP in Symptomatic and Asymptomatic Patients with Common Bile Duct Stones: A Propensity-Matched Analysis

2020 ◽  
Author(s):  
Lina Xiao ◽  
Chong Geng ◽  
Xiao Li ◽  
Yanni Li ◽  
Chunhui Wang
Keyword(s):  
Bile Duct ◽  
Postoperative Complications ◽  
Common Bile Duct ◽  
Acute Cholangitis ◽  
Common Bile Duct Stones ◽  
Bile Duct Stones ◽  
Endoscopic Retrograde ◽  
Cbd Stones ◽  
Asymptomatic Patients ◽  
Before And After

Abstract Background: The safety of endoscopic retrograde cholangiopancreatography (ERCP) for asymptomatic common bile duct (CBD) stones patients has not been fully studied. This study aimed to compare the incidence and severity of ERCP complications in patients with asymptomatic and symptomatic CBD stones and to provide evidence for the treatment of asymptomatic CBD stones.Methods: The clinical data of patients were retrospectively analyzed. These patients were divided into the asymptomatic CBD stones group and the symptomatic CBD stones group. Propensity score matching (PSM) was used to match the two groups. The incidence and severity of postoperative complications of ERCP in the two groups were analyzed.Results: A total of 79 patients who had asymptomatic CBD stones and 795 patients who had symptomatic CBD stones were included in this study. After PSM, 79 patients from asymptomatic CBD group and 316 patients from the symptomatic CBD stones group were identified. Before and after PSM, there were no significant differences in the incidence and severity of post-ERCP pancreatitis (PEP) between the two groups (P> 0.05). Besides, the incidence and severity of other complications including acute cholangitis, bleeding and perforation in the two groups was no differences before and after PSM (P>0.05).Conclusions: Patients with asymptomatic CBD stones are not at higher risk of getting ERCP-related complications when compared with those with symptomatic ones. ERCP is as safe and effective for asymptomatic CBD stones as for symptomatic patients.

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