Twenty Randomized Trials, One Ranking
This frequentist network meta-analysis of 20 randomized trials (2,489 patients) is the highest-level comparative evidence available across the four main strategies for gallstones with duct stones. Laparoscopic cholecystectomy plus LCBDE had the highest probability of being the least costly strategy (SUCRA 98.9%) with the shortest operative time (90.2%), and it best avoided acute pancreatitis (80.3%) and bleeding (83.3%). All four strategies had similar mortality. The single-stage surgical approach’s one consistent vulnerability was biliary leak — a complication of duct access and closure rather than of the concept itself, and the clearest remaining opportunity for device innovation in this space.
Citation
Ricci C, Pagano N, Taffurelli G, et al. Comparison of efficacy and safety of 4 combinations of laparoscopic and intraoperative techniques for management of gallstone disease with biliary duct calculi: a systematic review and network meta-analysis. JAMA Surg. 2018;153(7):e181167. doi:10.1001/jamasurg.2018.1167
