Four Times Less Pancreatitis Than Intraoperative ERCP
Zhu and colleagues pooled five randomized trials (860 patients) comparing the two true single-stage strategies: LCBDE plus cholecystectomy versus intraoperative rendezvous ERCP plus cholecystectomy. Technical success was equivalent (88.6% vs 89.6%). The decisive difference was pancreatitis — 2.0% after LCBDE versus 8.4% after intraoperative ERCP (P<.001) — reflecting that the surgical leaves the sphincter of Oddi intact. The trade-offs were a higher bile leak rate (2.6% vs 0.5%) and more retained stones with LCBDE. Those two residual weaknesses define the engineering agenda for the next generation of bile duct exploration: reliable antegrade drainage and confident duct clearance in a single operation.
Citation
Zhu J, Li G, Du P, et al. Laparoscopic common bile duct exploration versus intraoperative endoscopic retrograde cholangiopancreatography in patients with gallbladder and common bile duct stones: a meta-analysis. Surg Endosc. 2021;35:997-1005. doi:10.1007/s00464-020-08052-y
