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Destiny for Rendezvous: Is Cholecysto/Choledocholithiasis Better Treated with Dual- or Single-Step Procedures?

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Abstract

Biliary lithiasis is common worldwide, affecting almost 20% of the general population, though few experience symptoms. The frequency of choledocholithiasis in patients with symptomatic cholelithiasis is estimated to be 10–33%, depending on patients' age. Unlike gallbladder lithiasis, the medical and surgical treatment of common bile duct stones is uncertain, having changed over the last few years. The prior gold standard treatment for cholelithiasis and choledocholithiasis was open cholecystectomy with bile duct clearance, choledochotomy, and/or surgical sphincterotomy. In the last 10–15 years, new treatment approaches to the complex pathology of choledocholithiasis have emerged with the advent of endoscopic retrograde cholangiopancreatography (ERCP), laparoscopic surgery, and advanced diagnostic procedures. Although ERCP followed by laparoscopic cholecystectomy is the preferred mode of management, a single-step strategy (laparo-endoscopic rendezvous) has gained acceptance due to lesser morbidity and a lower risk of iatrogenic damage. Given the above, a tailored approach relying on careful evaluation of the disease is necessary in order to minimize complication risks and overall costs. Yet, the debate remains open, with no consensus on the superiority of laparo-endoscopic rendezvous to more conventional approaches.

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Abbreviations

CBD:

Common bile duct

CBDS:

Common bile duct stones

CNY:

Renminbi, the official currency of the People's Republic of China

CCY:

Cholecystectomy

CT:

Computed tomography

ERCP:

Endoscopic retrograde cholangiopancreatography

ES:

Endoscopic sphincterotomy

EUS:

Endoscopic ultrasound

IOC:

Intraoperative cholangiogram

LC:

Laparoscopic cholecystectomy

LCBDE:

Laparoscopic common bile duct exploration

LERV:

Laparo-endoscopic rendezvous

LFTs:

Liver function tests

MRCP:

Magnetic resonance cholangiopancreatography

MR:

Magnetic resonance

Post-ERCP:

Postoperative ERCP

Pre-ERCP:

Preoperative ERCP

RCS:

Randomized control study

RCTs:

Randomized control trials

SUCRA:

Surface under the cumulative curves

US:

Ultrasound

VUHI:

Vilnius University Hospital Index

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Authors and Affiliations

  1. Department of Surgical Sciences, Sapienza University, Rome, Italy

    S. Vaccari, A. Lauro, M. I. Bellini & V. D’Andrea

  2. Emergency Surgery Department, St. Orsola University Hospital, Bologna, Italy

    M. Minghetti, A. Ussia & V. Tonini

  3. Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA

    S. Khouzam & I. R. Marino

  4. Department of General Surgery, Ospedale Santissima Annunziata, Taranto, Italy

    M. Cervellera

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  1. S. Vaccari
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Vaccari, S., Minghetti, M., Lauro, A. et al. Destiny for Rendezvous: Is Cholecysto/Choledocholithiasis Better Treated with Dual- or Single-Step Procedures?. Dig Dis Sci 67, 1116–1127 (2022). https://doi.org/10.1007/s10620-022-07450-7

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