Advertisement

Outcomes following common bile duct exploration versus endoscopic stone extraction before, during and after laparoscopic cholecystectomy for patients with common bile duct stones

Published:August 28, 2022DOI:https://doi.org/10.1016/j.hpb.2022.08.014

      Abstract

      Background

      Laparoscopic common bile duct exploration (LCBDE) and endoscopic retrograde cholangiopancreatography (ERCP) are two methods of retrieving common bile duct (CBD) stones. The best method for CBD stone removal is debatable. The aim of this study was to compare outcomes following LCBDE and/or ERCP, including laparoscopic cholecystectomy.

      Methods

      Data were collected retrospectively for patients undergoing LCBDE and/or ERCP at a single centre from 2008 to 2018. Patients were grouped by intention-to-treat (single-stage LCBDE, pre-operative-, intra-operative-, or post-operative ERCP) and eventual plan (surgical or endoscopic). Outcomes included complication rates (minor Clavien-Dindo 1/2, major Clavien-Dindo 3/4, non-biliary complications) and mortality.

      Results

      Of 671 patients, 578 patients received LCBDE and 93 patients received ERCP as primary care. Endoscopic clearance had significantly higher complications and mortality compared to surgical clearance. On an intention-to-treat basis LCBDE had the lowest minor-, major- and non-biliary complications, and mortality (5.2%, 6.1%, 2.9% and 0.5%, respectively), whilst pre-operative ERCP the worst (39.6%, 27.1%, 29.2% and 8.3%, respectively) (p=<0.001). LCBDE and postERCP had similar major complications and mortality.

      Conclusion

      Surgical clearance of CBD stones was potentially safer than endoscopic clearance. Pre-operative ERCP had the worst outcomes. LCBDE and postERCP are likely to have similar short-term patient outcomes.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to HPB
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Snow L.L.
        • Weinstein L.S.
        • Hannon J.K.
        • Lane D.R.
        Evaluation of operative cholangiography in 2043 patients undergoing laparoscopic cholecystectomy: a case for the selective operative cholangiogram.
        Surg Endosc. 2001; 15: 14-20https://doi.org/10.1007/s004640000311
        • Collins C.
        • Maguire D.
        • Ireland A.
        • Fitzgerald E.
        • O'Sullivan G.C.
        A prospective study of common bile duct calculi in patients undergoing laparoscopic cholecystectomy: natural history of choledocholithiasis revisited.
        Ann Surg. 2004; 239: 28-33https://doi.org/10.1097/01.sla.0000103069.00170.9c
        • Horwood J.
        • Akbar F.
        • Davis K.
        • Morgan R.
        Prospective evaluation of a selective approach to cholangiography for suspected common bile duct stones.
        Ann R Coll Surg Engl. 2010; 92: 206-210https://doi.org/10.1308/003588410x12628812458293
        • Cianci P.
        • Restini E.
        Management of cholelithiasis with choledocholithiasis: endoscopic and surgical approaches.
        World J Gastroenterol. 2021; 27: 4536-4554https://doi.org/10.3748/wjg.v27.i28.4536
        • Li Z.Q.
        • Sun J.X.
        • Li B.
        • Dai X.Q.
        • Yu A.X.
        • Li Z.F.
        Meta-analysis of single-stage versus two-staged management for concomitant gallstones and common bile duct stones.
        J Minimal Access Surg. 2020; 16: 206-214https://doi.org/10.4103/jmas.JMAS_146_18
        • Lyu Y.
        • Cheng Y.
        • Li T.
        • Cheng B.
        • Jin X.
        Laparoscopic common bile duct exploration plus cholecystectomy versus endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy for cholecystocholedocholithiasis: a meta-analysis.
        Surg Endosc. 2019; 33: 3275-3286https://doi.org/10.1007/s00464-018-06613-w
        • Salman B.
        • Yilmaz U.
        • Kerem M.
        • Bedirli A.
        • Sare M.
        • Sakrak O.
        • et al.
        The timing of laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreaticography in cholelithiasis coexisting with choledocholithiasis.
        J Hepatobiliary Pancreat Surg. 2009; 16: 832-836https://doi.org/10.1007/s00534-009-0169-4
        • Ricci C.
        • Pagano N.
        • Taffurelli G.
        • Pacilio C.A.
        • Migliori M.
        • Bazzoli F.
        • et al.
        Comparison of efficacy and safety of 4 combinations of laparoscopic and intraoperative techniques for management of gallstone disease with biliary duct calculi: a systematic review and network meta-analysis.
        JAMA Surg. 2018; 153e181167https://doi.org/10.1001/jamasurg.2018.1167
        • Dindo D.
        • Demartines N.
        • Clavien P.A.
        Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.
        Ann Surg. 2004; 240: 205-213https://doi.org/10.1097/01.sla.0000133083.54934.ae
        • Buxbaum J.L.
        • Abbas Fehmi S.M.
        • Sultan S.
        • Fishman D.S.
        • Qumseya B.J.
        • Cortessis V.K.
        • et al.
        ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis.
        Gastrointest Endosc. 2019; 89 (e15): 1075-1105https://doi.org/10.1016/j.gie.2018.10.001
        • Pan L.
        • Chen M.
        • Ji L.
        • Zheng L.
        • Yan P.
        • Fang J.
        • et al.
        The safety and efficacy of laparoscopic common bile duct exploration combined with cholecystectomy for the management of cholecysto-choledocholithiasis: an up-to-date meta-analysis.
        Ann Surg. 2018; 268: 247-253https://doi.org/10.1097/sla.0000000000002731
        • Zhu J.
        • Li G.
        • Du P.
        • Zhou X.
        • Xiao W.
        • Li Y.
        Laparoscopic common bile duct exploration versus intraoperative endoscopic retrograde cholangiopancreatography in patients with gallbladder and common bile duct stones: a meta-analysis.
        Surg Endosc. 2021; 35: 997-1005https://doi.org/10.1007/s00464-020-08052-y
        • Singh A.N.
        • Kilambi R.
        Single-stage laparoscopic common bile duct exploration and cholecystectomy versus two-stage endoscopic stone extraction followed by laparoscopic cholecystectomy for patients with gallbladder stones with common bile duct stones: systematic review and meta-analysis of randomized trials with trial sequential analysis.
        Surg Endosc. 2018; 32: 3763-3776https://doi.org/10.1007/s00464-018-6170-8
        • Tan C.
        • Ocampo O.
        • Ong R.
        • Tan K.S.
        Comparison of one stage laparoscopic cholecystectomy combined with intra-operative endoscopic sphincterotomy versus two-stage pre-operative endoscopic sphincterotomy followed by laparoscopic cholecystectomy for the management of pre-operatively diagnosed patients with common bile duct stones: a meta-analysis.
        Surg Endosc. 2018; 32: 770-778https://doi.org/10.1007/s00464-017-5739-y
        • Gao M.J.
        • Jiang Z.L.
        Effects of the timing of laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatography on liver, bile, and inflammatory indices and cholecysto-choledocholithiasis patient prognoses.
        Clinics. 2021; 76: e2189https://doi.org/10.6061/clinics/2021/e2189
        • Lei C.
        • Lu T.
        • Yang W.
        • Yang M.
        • Tian H.
        • Song S.
        • et al.
        Comparison of intraoperative endoscopic retrograde cholangiopancreatography and laparoscopic common bile duct exploration combined with laparoscopic cholecystectomy for treating gallstones and common bile duct stones: a systematic review and meta-analysis.
        Surg Endosc. 2021; 35: 5918-5935https://doi.org/10.1007/s00464-021-08648-y
        • Williams E.
        • Beckingham I.
        • El Sayed G.
        • Gurusamy K.
        • Sturgess R.
        • Webster G.
        • et al.
        Updated guideline on the management of common bile duct stones (CBDS).
        Gut. 2017; 66: 765-782https://doi.org/10.1136/gutjnl-2016-312317
        • Vakayil V.
        • Klinker S.T.
        • Sulciner M.L.
        • Mallick R.
        • Trikudanathan G.
        • Amateau S.K.
        • et al.
        Single-stage management of choledocholithiasis: intraoperative ERCP versus laparoscopic common bile duct exploration.
        Surg Endosc. 2020; 34: 4616-4625https://doi.org/10.1007/s00464-019-07215-w
        • Nagaraja V.
        • Eslick G.D.
        • Cox M.R.
        Systematic review and meta-analysis of minimally invasive techniques for the management of cholecysto-choledocholithiasis.
        J Hepatobiliary Pancreat Sci. 2014; 21: 896-901https://doi.org/10.1002/jhbp.152
        • Hong D.F.
        • Xin Y.
        • Chen D.W.
        Comparison of laparoscopic cholecystectomy combined with intraoperative endoscopic sphincterotomy and laparoscopic exploration of the common bile duct for cholecystocholedocholithiasis.
        Surg Endosc. 2006; 20: 424-427https://doi.org/10.1007/s00464-004-8248-8
        • ElGeidie A.A.
        • ElShobary M.M.
        • Naeem Y.M.
        Laparoscopic exploration versus intraoperative endoscopic sphincterotomy for common bile duct stones: a prospective randomized trial.
        Dig Surg. 2011; 28: 424-431https://doi.org/10.1159/000331470
        • Barreras González J.E.
        • Torres Peña R.
        • Ruiz Torres J.
        • Martínez Alfonso M.
        • Brizuela Quintanilla R.
        • Morera Pérez M.
        Endoscopic versus laparoscopic treatment for choledocholithiasis: a prospective randomized controlled trial.
        Endosc Int Open. 2016; 4 (E1188-e93)https://doi.org/10.1055/s-0042-116144
        • Poh B.R.
        • Ho S.P.
        • Sritharan M.
        • Yeong C.C.
        • Swan M.P.
        • Devonshire D.A.
        • et al.
        Randomized clinical trial of intraoperative endoscopic retrograde cholangiopancreatography versus laparoscopic bile duct exploration in patients with choledocholithiasis.
        Br J Surg. 2016; 103: 1117-1124https://doi.org/10.1002/bjs.10207
        • Rhodes M.
        • Sussman L.
        • Cohen L.
        • Lewis M.P.
        Randomised trial of laparoscopic exploration of common bile duct versus postoperative endoscopic retrograde cholangiography for common bile duct stones.
        Lancet. 1998; 351: 159-161https://doi.org/10.1016/s0140-6736(97)09175-7
        • Nathanson L.K.
        • O'Rourke N.A.
        • Martin I.J.
        • Fielding G.A.
        • Cowen A.E.
        • Roberts R.K.
        • et al.
        Postoperative ERCP versus laparoscopic choledochotomy for clearance of selected bile duct calculi: a randomized trial.
        Ann Surg. 2005; 242: 188-192https://doi.org/10.1097/01.sla.0000171035.57236.d7
        • Bansal V.K.
        • Misra M.C.
        • Rajan K.
        • Kilambi R.
        • Kumar S.
        • Krishna A.
        • et al.
        Single-stage laparoscopic common bile duct exploration and cholecystectomy versus two-stage endoscopic stone extraction followed by laparoscopic cholecystectomy for patients with concomitant gallbladder stones and common bile duct stones: a randomized controlled trial.
        Surg Endosc. 2014; 28: 875-885https://doi.org/10.1007/s00464-013-3237-4
        • Bansal V.K.
        • Misra M.C.
        • Garg P.
        • Prabhu M.
        A prospective randomized trial comparing two-stage versus single-stage management of patients with gallstone disease and common bile duct stones.
        Surg Endosc. 2010; 24: 1986-1989https://doi.org/10.1007/s00464-010-0891-7
        • Rogers S.J.
        • Cello J.P.
        • Horn J.K.
        • Siperstein A.E.
        • Schecter W.P.
        • Campbell A.R.
        • et al.
        Prospective randomized trial of LC+LCBDE vs ERCP/S+LC for common bile duct stone disease.
        Arch Surg. 2010; 145: 28-33https://doi.org/10.1001/archsurg.2009.226
        • Topal B.
        • Vromman K.
        • Aerts R.
        • Verslype C.
        • Van Steenbergen W.
        • Penninckx F.
        Hospital cost categories of one-stage versus two-stage management of common bile duct stones.
        Surg Endosc. 2010; 24: 413-416https://doi.org/10.1007/s00464-009-0594-0
        • Gilsdorf D.
        • Henrichsen J.
        • Liljestrand K.
        • Staheli A.
        • Olsen G.
        • Narayanan P.
        • et al.
        Laparoscopic common bile duct exploration for choledocholithiasis: analysis of practice patterns of intermountain HealthCare.
        J Am Coll Surg. 2018; 226: 1160-1165https://doi.org/10.1016/j.jamcollsurg.2018.02.008
        • Zhu J.
        • Tu S.
        • Yang Z.
        • Fu X.
        • Li Y.
        • Xiao W.
        Laparoscopic common bile duct exploration for elderly patients with choledocholithiasis: a systematic review and meta-analysis.
        Surg Endosc. 2020; 34: 1522-1533https://doi.org/10.1007/s00464-020-07394-x
        • Lee A.
        • Min S.K.
        • Park J.J.
        • Lee H.K.
        Laparoscopic common bile duct exploration for elderly patients: as a first treatment strategy for common bile duct stones.
        J Korean Surg Soc. 2011; 81: 128-133https://doi.org/10.4174/jkss.2011.81.2.128
        • Johnson K.D.
        • Perisetti A.
        • Tharian B.
        • Thandassery R.
        • Jamidar P.
        • Goyal H.
        • et al.
        Endoscopic retrograde cholangiopancreatography-related complications and their management strategies: a "scoping" literature review.
        Dig Dis Sci. 2020; 65: 361-375https://doi.org/10.1007/s10620-019-05970-3
        • Matsui Y.
        • Hirooka S.
        • Yamaki S.
        • Kotsuka M.
        • Kosaka H.
        • Yamamoto T.
        • et al.
        Assessment of clinical outcome of cholecystectomy according to age in preparation for the "Silver Tsunami".
        Am J Surg. 2019; 218: 567-570https://doi.org/10.1016/j.amjsurg.2019.01.021
        • Zhou Y.
        • Zha W.Z.
        • Fan R.G.
        • Jiang G.Q.
        • Wu X.D.
        Two-stage versus single-stage procedure for the management of cholecystocholedocholithiasis in elderly patients: a retrospectively cohort study.
        Rev Esp Enferm Dig. 2019; 111: 176-181https://doi.org/10.17235/reed.2018.5822/2018