Brief Article
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World J Gastroenterol. Jun 28, 2012; 18(24): 3156-3166
Published online Jun 28, 2012. doi: 10.3748/wjg.v18.i24.3156
Two-stage vs single-stage management for concomitant gallstones and common bile duct stones
Jiong Lu, Yao Cheng, Xian-Ze Xiong, Yi-Xin Lin, Si-Jia Wu, Nan-Sheng Cheng
Jiong Lu, Yao Cheng, Xian-Ze Xiong, Yi-Xin Lin, Si-Jia Wu, Nan-Sheng Cheng, Department of Bile Duct Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Lu J and Cheng NS designed the study; Lu J, Cheng Y and Xiong XZ performed the literature search and collected the data; Lin YX and Wu SJ analyzed the data; Lu J and Cheng Y wrote the paper.
Correspondence to: Nan-Sheng Cheng, MD, Professor, Department of Bile Duct Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, China. nanshengcheng@gmail.com
Telephone: +86-28-85422461 Fax: +86-28-85422462
Received: October 24, 2011
Revised: February 20, 2012
Accepted: February 26, 2012
Published online: June 28, 2012
Abstract

AIM: To evaluate the safety and effectiveness of two-stage vs single-stage management for concomitant gallstones and common bile duct stones.

METHODS: Four databases, including PubMed, Embase, the Cochrane Central Register of Controlled Trials and the Science Citation Index up to September 2011, were searched to identify all randomized controlled trials (RCTs). Data were extracted from the studies by two independent reviewers. The primary outcomes were stone clearance from the common bile duct, postoperative morbidity and mortality. The secondary outcomes were conversion to other procedures, number of procedures per patient, length of hospital stay, total operative time, hospitalization charges, patient acceptance and quality of life scores.

RESULTS: Seven eligible RCTs [five trials (n = 621) comparing preoperative endoscopic retrograde cholangiopancreatography (ERCP)/endoscopic sphincterotomy (EST) + laparoscopic cholecystectomy (LC) with LC + laparoscopic common bile duct exploration (LCBDE); two trials (n = 166) comparing postoperative ERCP/EST + LC with LC + LCBDE], composed of 787 patients in total, were included in the final analysis. The meta-analysis detected no statistically significant difference between the two groups in stone clearance from the common bile duct [risk ratios (RR) = -0.10, 95% confidence intervals (CI): -0.24 to 0.04, P = 0.17], postoperative morbidity (RR = 0.79, 95% CI: 0.58 to 1.10, P = 0.16), mortality (RR = 2.19, 95% CI: 0.33 to 14.67, P = 0.42), conversion to other procedures (RR = 1.21, 95% CI: 0.54 to 2.70, P = 0.39), length of hospital stay (MD = 0.99, 95% CI: -1.59 to 3.57, P = 0.45), total operative time (MD = 12.14, 95% CI: -1.83 to 26.10, P = 0.09). Two-stage (LC + ERCP/EST) management clearly required more procedures per patient than single-stage (LC + LCBDE) management.

CONCLUSION: Single-stage management is equivalent to two-stage management but requires fewer procedures. However, patient’s condition, operator’s expertise and local resources should be taken into account in making treatment decisions.

Keywords: Laparoscopic cholecystectomy, Laparoscopic common bile duct exploration, Endoscopic retrograde cholangiopancreatography, Endoscopic sphincterotomy, Gallstones, Common bile duct stones, Meta-analysis