title: Laparoendoscopic rendezvous versus preoperative ERCP and laparoscopic cholecystectomy for the management of cholecysto-choledocholithiasis: interim analysis of a controlled randomized trial.
abstract: BACKGROUND
  Although the ideal management of cholecysto-choledocholi-thiasis is controversial, the 2-stage approach [endoscopic retrograde cholangiopancreatography (ERCP), sphincterotomy, and common bile duct (CBD) clearance followed by laparoscopic cholecystectomy] remains the standard way of management worldwide. One-stage approach using the so-called laparoendoscopic rendezvous (LERV) technique offers some advantages, mainly by reducing the hospital stay and the risk of post-ERCP pancreatitis.
  
  
  OBJECTIVE
  To compare the LERV 1-stage approach with the standard 2-stage approach consisting of preoperative ERCP followed by laparoscopic cholecystectomy for the treatment of cholecysto-choledocholithiasis.
  
  
  METHODS
  Controlled randomized trial, University/Teaching Hospital.
  
  
  METHODS
  : Patients with cholecysto-choledocholithiasis were randomized either to LERV or to the 2-stage approach. Both elective and emergency cases were included in the study. Primary endpoint was to detect difference in overall hospital stay, whereas secondary endpoints were (i) to detect differences in morbidity (especially post-ERCP pancreatitis) and (ii) success of CBD clearance. This is an interim analysis of the first 100 randomized patients.
  
  
  RESULTS
  Hospital stay was significantly shorter in the LERV group; median 4 (2-19) days versus 5.5 (3-22) days, P = 0.0004. There was no difference in morbidity and success of CBD clearance between the 2 groups. Post-ERCP amylase value was found significantly lower in the LERV group: median 65 (16-1159) versus 91 (30-1846), P = 0.02.
  
  
  CONCLUSIONS
  Interim analysis of the results suggests the superiority of the LERV technique in terms of hospital stay and post-ERCP hyperamylasemia.
authors.affiliation: Department of Surgery, University of Thessaly Medical School, University Hospital of Larissa, Larissa, Greece. gtzovaras@hotmail.com
authors.forename: George
authors.initials: G
authors.lastname: Tzovaras
authors.forename: Ioannis
authors.initials: I
authors.lastname: Baloyiannis
authors.forename: Eleni
authors.initials: E
authors.lastname: Zachari
authors.forename: Dimitris
authors.initials: D
authors.lastname: Symeonidis
authors.forename: Dimitris
authors.initials: D
authors.lastname: Zacharoulis
authors.forename: Andreas
authors.initials: A
authors.lastname: Kapsoritakis
authors.forename: George
authors.initials: G
authors.lastname: Paroutoglou
authors.forename: Spyros
authors.initials: S
authors.lastname: Potamianos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic; D041761:Cholecystolithiasis / Q000150:complications / Q000601:surgery*; D042883:Choledocholithiasis / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011446:Prospective Studies; D055815:Young Adult