Single-step laparoscopic surgery reduces postoperative morbidity in the management of gallstones

Table 1 Characteristics of included trials

Ref.	Country	Number of recruited patients	Age in years	Female:Male	Duration of follow up	Trial running time
Farid et al[13], 2024	Egypt	LERV: 218; No LERV: 218	LERV: 39.56 ± 12.31; No LERV: 44.44 ± 10.18	LERV: 93:125; No LERV: 156:62	1 year	January 2010 to April 2022
Lella et al[14], 2006	Italy	LERV: 60; No LERV: 60	LERV: 54.2 ± 9.51	LERV: 33:27; No LERV: 35:25	24 hours	January 2002 to September 2004
Morino et al[15], 2006	Italy	LERV: 46; No LERV: 45	LERV: 56.6 ± 151; No LERV: 63.1 ± 14.51	LERV: 31:15; No LERV: 25:20	20 months	May 2001 to August 2005
Rábago et al[16], 2006	Spain	LERV: 64; No LERV: 59	Not reported	Not reported	24 months	June 1999 to June 2003
Sahoo et al[17], 2014	India	LERV: 42; No LERV: 41	LERV: 47.95 ± 13.51	LERV: 53:30	30 days	2005 to 2012
Tzovaras et al[18], 2012	Greece	LERV: 50; No LERV: 49	LERV: 66 ± 16.251; No LERV: 69 ± 151	LERV: 27:23; No LERV: 26:23	Not reported	September 2006 to April 2009

¹SD estimated from range.

LERV: Laparoscopic-endoscopic rendezvous.

Table 2 Treatment protocol adopted in included trials

Ref.	LERV	No-LERV
Farid et al[13], 2024	Treated by a single-step procedure combining laparoscopic cholecystectomy and intraoperative endoscopic sphincterotomy	Treated by a two-step (sequential treatment) preoperative endoscopic sphincterotomy followed by laparoscopic cholecystectomy; scheduling for laparoscopic cholecystectomy in the control group ranged from within 8 weeks after preoperative ERCP
Lella et al[14], 2006	Patients in group A underwent a single-session procedure under general anesthesia, starting with intraoperative cholangiography to confirm duct stones; following this, a video duodenoscope was used for ERCP, facilitated by a surgeon-placed guidewire through the cystic duct for rapid papillary cannulation, sphincterotomy, and stone removal, after which cholecystectomy was completed	Treated with preoperative ERCP and EST using a traditional method of bile duct cannulation; all patients in the control group were scheduled for laparoscopic cholecystectomy within 24 hours to 48 hours after ERCP; No drugs for prophylactic prevention of post-ERCP pancreatitis were administered before the two procedures; treated by the same endoscopist with experience of 200 ERCPs a year
Morino et al[15], 2006	The intervention group underwent laparoscopic cholecystectomy associated with intraoperative ERCP and ES according to the rendezvous technique	Patients underwent a pre-op ERCP with endoscopic sphincterotomy (ES) followed by laparoscopic cholecystectomy in the same hospital admission
Rábago et al[16], 2006	Intraoperative cholangiography during laparoscopic cholecystectomy, and if stones were found, an intraoperative ERCP was performed	Patients treated with the standard 2-step treatment, pre-op ERCP followed by laparoscopic cholecystectomy within the next 8 weeks, provided that no post-ERCP complication had occurred
Sahoo et al[17], 2014	Patients were treated with LC and intra-operative cholangiography, and when the diagnosis of choledocholithiasis was confirmed, patients had undergone one-step management by the laparo-endoscopic rendezvous technique; included patients were diagnosed with cholelithiasis and choledocholithiasis	Treated with the first stage of pre-operative ERCP and CBD clearance by standard technique, and a second step of a classical four-port laparoscopic cholecystectomy
Tzovaras et al[18], 2012	The intervention group was offered the 1-step LERV technique; only patients with a positive MRCP were included in the study	Patients treated with standard 2-step treatment; pre-op ERCP followed by laparoscopic cholecystectomy within the next 48 hours, provided that no post-ERCP complication had occurred

LERV: Laparoscopic-endoscopic rendezvous; ERCP: Endoscopic retrograde cholangiopancreatography; MRCP: Magnetic resonance cholangiopancreatography; LC: Laparoscopic cholecystectomy; CBD: Common bile duct; ES: Endoscopic sphincterotomy.

Table 3 Risk of bias assessment

Ref.	Randomization technique	Power calculations	Blinding	Intention-to-treat analysis	Concealment	Inclusion criteria	Exclusion criteria
Farid et al[13], 2024	1:1 allocation via computer-generated random numbers	Not reported	Not reported	No	Yes	Reported	Reported
Lella et al[14], 2006	1:1 allocation via computer-generated random numbers	Reported	Not reported	No	No	Reported	Reported
Morino et al[15], 2006	1:1 allocation via computer-generated random numbers	Reported	Not reported	Yes	Yes	Reported	Reported
Rábago et al[16], 2006	Allocation via random number generation	Reported	Not reported	Yes	Yes	Reported	Reported
Sahoo et al[17], 2014	1:1 allocation via computer-generated random numbers	Not reported	Not reported	No	Yes	Reported	Reported
Tzovaras et al[18], 2012	1:1 allocation via block randomization	Reported	Not reported	Yes	Yes	Reported	Reported