Minimally invasive management of concomitant gallstones and common bile duct stones: an updated network meta-analysis of randomized controlled trials

Jisheng Zhu; Guiyan Wang; Bin Xie; Zhengying Jiang; Weidong Xiao; Yong Li

doi:10.1007/s00464-022-09723-8

Minimally invasive management of concomitant gallstones and common bile duct stones: an updated network meta-analysis of randomized controlled trials

Surg Endosc. 2023 Mar;37(3):1683-1693. doi: 10.1007/s00464-022-09723-8. Epub 2022 Oct 24.

Authors

Jisheng Zhu^#¹, Guiyan Wang^#², Bin Xie¹, Zhengying Jiang³, Weidong Xiao¹, Yong Li⁴

Affiliations

¹ Department of General Surgery, The First Affiliated Hospital of Nanchang University, No. 17 Yongwai Zhengjie, Nanchang, 330006, Jiangxi, China.
² Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17 Yongwai Zhengjie, Nanchang, 330006, Jiangxi, China.
³ Department of Burn, The First Affiliated Hospital of Nanchang University, No. 17 Yongwai Zhengjie, Nanchang, 330006, Jiangxi, China.
⁴ Department of General Surgery, The First Affiliated Hospital of Nanchang University, No. 17 Yongwai Zhengjie, Nanchang, 330006, Jiangxi, China. cdyfyly@126.com.

^# Contributed equally.

PMID: 36278995
DOI: 10.1007/s00464-022-09723-8

Abstract

Background: To update a 2018 meta-analysis on the comparative efficacy and safety of four surgical techniques in patients with concomitant gallstones and common bile duct (CBD) stones.

Methods: Randomized controlled trials (RCTs) comparing laparoscopic cholecystectomy (LC) plus laparoscopic common bile duct exploration (LCBDE), LC plus preoperative endoscopic retrograde cholangiopancreatography (PreERCP), LC plus intraoperative ERCP (IntraERCP), and LC plus postoperative ERCP (PostERCP) were included. Primary and secondary outcomes were compared using odds ratio, weighted mean difference, and 95% confidence intervals.

Results: Twenty-five RCTs involved 3145 patients were included. Of these, 1188 (37.8%) underwent LC + PreERCP, 1183 (37.6%) LC + LCBDE, 689 (21.9%) LC + IntraERCP, and 85 (2.7%) LC + PostERCP. This analysis demonstrated that LC plus IntraERCP was the most likely approach to achieve technical success and reduce morbidity. No significant differences were observed between the four treatments concerning major morbidity, mortality, and operative time. LC plus LCBDE was effective for increasing biliary leak and conversion as well as decreasing postoperative hemorrhage and total costs. Additionally, LC plus PreERCP was associated with higher postoperative pancreatitis, while LC plus IntraERCP was associated with a shorter length of hospital stay. There was significant heterogeneity in operative time, hospital stay, and total costs (τ² > 1).

Conclusions: This analysis provides evidence that LC plus IntraERCP appears to be the optimal strategy for patients with concomitant gallstones and CBD stones owing to its advantage in technical success and morbidity. LC plus LCBDE is associated with higher biliary leak and lower postoperative hemorrhage, whereas LC plus PreERCP is associated with higher postoperative pancreatitis.

Keywords: Common bile duct stones; Endoscopic; Laparoscopic; Network meta-analysis.

Publication types

Meta-Analysis
Review

MeSH terms

Cholangiopancreatography, Endoscopic Retrograde / methods
Cholecystectomy, Laparoscopic* / methods
Choledocholithiasis* / complications
Choledocholithiasis* / surgery
Common Bile Duct / surgery
Gallstones* / complications
Gallstones* / surgery
Humans
Network Meta-Analysis
Pancreatitis* / complications
Pancreatitis* / surgery
Postoperative Hemorrhage / surgery
Randomized Controlled Trials as Topic
Sphincterotomy, Endoscopic / methods