Current status of laparoendoscopic rendezvous in the treatment of cholelithiasis with concomitant choledocholithiasis

Abstract

The current evidence in favor of the laparoendoscopic rendezvous is promising and demonstrates the main advantages of this technique in regard to shorter hospital stay and selective cannulation of the common bile duct (CBD), avoiding thus the inadvertent cannulation of the pancreatic duct. In addition, in the rendezvous technique the contrast medium is not injected retrogradely as during the traditional endoscopic retrograde cholangiopancreatography (ERCP), when the medium accidentally could be injected under pressure into the pancreatic duct. The RV technique minimizes that risk. Both these main advantages of the RV technique over the classic ERCP, are related with a significant lower incidence of hyperamylasemia and post-ERCP pancreatitis, compared with the traditional two stage procedure. Choledocholithiasis is present in 10% to 15% of patients undergoing cholecystectomy. To date, the ideal management of CBD stones remains controversial. Prospective randomized trials have shown that laparoscopic management of the CBD stones, as a single stage procedure, is the most efficient and cost effective method of treatment. Laparoendoscopic rendezvous has been proposed as an alternative single stage approach. Several studies have shown the effective use of this technique in the treatment of CBD stones by improving patient compliance and clinical results including shorter hospital stay, higher success rate and less cost. The current evidence about the use of this technique presented in this review article is promising and demonstrates the main advantages of the procedure.

Keywords: Common bile duct stones, Laparoendoscopic rendezvous, Endoscopic retrograde cholangiopancreatography, Cholecysto-choledocholithiasis, Laparoscopic cholecystectomy

Core tip: This is a review article for the laparoendoscopic rendezvous technique - a promising single stage procedure in the treatment of patients with cholecysto-choledocholithiasis. In this article we highlight the main advantages of the procedure compared to the traditional two stage approach [preoperative endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy]. These advantages include the selective cannulation of the common bile duct and the avoidance of high pressure injection of the contrast medium into the pancreatic duct. Both factors are directly related with the pathogenesis of post-ERCP pancreatitis. The current evidence demonstrated in this paper is in favor of the laparoendoscopic rendezvous, however, this technique is still not widely accepted.