Abstract | OBJECTIVE: BACKGROUND: It remains controversial whether LCBDE+LC is better than pre-EST+LC for gallstones and CBD stones. METHODS: A specific search of online databases was performed from January 2006 to October 2017. Relative outcomes of perioperative safety and postoperative efficacy were synthesized. Single-arm meta-analysis and cumulative meta-analysis were also conducted. RESULTS: A total of 13 studies involving 1757 (872 vs 885) patients were included for analysis in our study. The CBD stones clearance rate [94.1% vs 90.1%; odds ratio (OR) 1.56, P = 0.012] was significantly higher in patients who underwent LCBDE+LC than pre-EST+LC, while perioperative complications (7.6% vs 12.0%; OR 0.67, P = 0.015), conversion to other procedure (4.1% vs 7.1%; OR 0.64, P = 0.025), retained stones rate (1.2% vs 7.9%; OR 0.34, P = 0.004), lithiasis recurrence rate (1.8% vs 5.6%, OR 0.32, P = 0.005), operative time [112.28 vs 132.03 minutes; weighted mean difference (WMD) -18.08, P = 0.002], length of hospital stay (4.94 vs 6.62 days; WMD -1.63, P = 0.023), and total charges [standardized mean difference (SMD) -2.76, P = 0.002] were significantly lower in LCBDE+LC. The mortality (0.6% vs 1.1%; OR 0.32, P = 0.117) was similar between the 2 groups. The cumulative meta-analyses indicated the effect sizes of CBD stones clearance rate, perioperative complications, and conversion to other procedure have already stabilized between 2 groups. CONCLUSION: The updated meta-analysis first confirms that LCBDE+LC is superior to pre-EST+LC both in perioperative safety and short- and long-term postoperative efficacy, which should be considered as optimal treatment choice for cholecysto- choledocholithiasis.
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Authors | Long Pan, Mingyu Chen, Lin Ji, Longbo Zheng, Peijian Yan, Jing Fang, Bin Zhang, Xiujun Cai |
Journal | Annals of surgery
(Ann Surg)
Vol. 268
Issue 2
Pg. 247-253
(08 2018)
ISSN: 1528-1140 [Electronic] United States |
PMID | 29533266
(Publication Type: Comparative Study, Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't)
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Topics |
- Cholangiopancreatography, Endoscopic Retrograde
- Cholecystectomy, Laparoscopic
(methods)
- Choledocholithiasis
(complications, diagnostic imaging, surgery)
- Gallstones
(complications, diagnostic imaging, surgery)
- Humans
- Models, Statistical
- Odds Ratio
- Sphincterotomy, Endoscopic
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