38 Laparoscopic Surgery Versus Endoscopy in the Management Common Bile Duct Stones: Systematic Review and Meta-Analysis

Abstract

Abstract Introduction The objective of this study is to assess whether a 1 stage Laparoscopic Common Bile Duct Exploration (LCBDE) followed by Laparoscopic Cholecystectomy (LC) should be the gold standard in managing CBD stones by comparing the clearance rate of common bile duct stones, morbidity, mortality, and the duration of hospital stay with ERCP+LC. Method This systematic review with a meta-analysis included RCTs of patients who were treated by the LCBDE/LC versus ERCP+LC. RCTs were collected using PRISMA guidelines by 2 authors Independently from Cochrane central register of controlled trials, Medline and Embase. Review Manager was used for Statistical analysis using the Mantel–Haenszel method. The results were plotted on a Forest Plot diagram and then compared. Results 849 patients from 7 RCTs were included in the study, 426 patients in the ERCP+LC arm and 423 in the LCBDE/LC arm. According to the Meta-analysis, Laparoscopic Common Bile Duct Exploration with Cholecystectomy was significantly superior to ERCP + LC in terms of successful Clearance of CBD stone, mortality rate and Acute Pancreatitis. but had significantly higher rates in biliary leakages. There were no significant differences in Surgical Site Infections, Haemorrhages, Acute Cholangitis, Perforations, or duration of hospital stay. Conclusion LCBDE/LC is superior in successful CBD stone clearance, mortality, and acute pancreatitis. Further RCTs will be needed to assess overall Morbidity, surgical site infections, Haemorrhages, Acute Cholangitis, perforations, or duration of hospital stay. Therefore, LCBDE/LC should be considered as the gold standard in clearing CBD stones.