COMMENTARY

Surgical Management of Cholecystocholedocholithiasis: 1 or 2 Steps?

Albert B. Lowenfels, MD

Disclosures

May 18, 2012

Laparoendoscopic Rendezvous Versus Preoperative ERCP and Laparoscopic Cholecystectomy for the Management of Cholecysto-Choledocholithiasis: Interim Analysis of a Controlled Randomized Trial

Tzovaras G, Baloyiannis I, Zachari E, et al
Ann Surg. 2012;255:435-439

Summary

The investigators conducted a randomized trial to compare a single-stage "rendezvous" operative approach for patients with proven stone-related biliary tract disease (n = 50) with the conventional 2-stage approach, in which preliminary endoscopic retrograde cholangiopancreatography (ERCP) bile duct clearance is followed by traditional laparoscopic cholecystectomy (n = 49).

Hospital stay was 1.5 days shorter in patients with the single operative procedure (P < .001), and postoperative mean serum amylase levels were lower (P = .02). None of the study patients developed pancreatitis, and the number of postoperative complications was similar in each group.

Viewpoint

A single-stage operative approach to the management of patients with proven common duct stones should be superior to an approach that requires preoperative ERCP because it avoids the possibility of iatrogenic acute pancreatitis and results in a shorter length of stay. The main benefit of this trial, which had equal numbers of emergent patients in each group, was a significant reduction in hospital stay. Other trials have demonstrated the benefit of a single operative procedure, but the 2-stage approach (initial ERCP followed by laparoscopic cholecystectomy) remains popular because the logistics are perceived to be simpler.

Abstract

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