title: Randomised study on single stage laparo-endoscopic rendezvous (intra-operative ERCP) procedure versus two stage approach (Pre-operative ERCP followed by laparoscopic cholecystectomy) for the management of cholelithiasis with choledocholithiasis.
abstract: BACKGROUND
  The 'Rendezvous' technique consists of laparoscopic cholecystectomy (LC) standards with intra-operative cholangiography followed by endoscopic sphincterotomy. The sphincterotome is driven across the papilla through a guidewire inserted by the transcystic route. In this study, we intended to compare the two methods in a prospective randomised trial.
  
  
  METHODS
  From 2005 to 2012, we enrolled 83 patients with a diagnosis of cholecysto-choledocolithiasis. They were randomised into two groups. In 'group-A',41 patients were treated with two stages management, first by pre-operative endoscopic retrograde cholangiopancreatography (ERCP) and common bile duct (CBD) clearance and second by LC. In 'group-B', 42 patients were treated with LC and intra-operative cholangiography; and when diagnosis of choledocholithiasis was confirmed, patients had undergone one stage management of by Laparo-endoscopic Rendezvous technique.
  
  
  RESULTS
  In arm-A and arm-B groups, complete CBD clearance was achieved in 29 and 38 patients, respectively. Failure of the treatment in arm-A was 29% and in arm-B was 9.5%. In arm-A, selective CBD cannulation was achieved in 33 cases (80.5%) and in arm-B in 39 cases (93%). In arm-Agroup, post-ERCP hyperamylasia was presented in nine patients (22%) and severe pancreatitis in five patients (12%) versus none of the patients (0%) in arm-B group, respectively. Mean post-operative hospital stay in arm-A and arm-B groups are 10.9 and 6.8 days, respectively.
  
  
  CONCLUSIONS
  One stage laparo-endoscopic rendezvous approach increases selective cannulation of CBD, reduces post-ERCP pancreatitis, reduces days of hospital stay, increases patient's compliance and prevents unnecessary intervention to CBD.
authors.affiliation: Department of Surgery, Shrirama Chandra Bhanj Medical College, Cuttack, Odisha, India.
authors.forename: Manash Ranjan
authors.initials: MR
authors.lastname: Sahoo
authors.affiliation: Department of Surgery, Shrirama Chandra Bhanj Medical College, Cuttack, Odisha, India.
authors.forename: Anil T
authors.initials: AT
authors.lastname: Kumar
authors.affiliation: Department of Surgery, Shrirama Chandra Bhanj Medical College, Cuttack, Odisha, India.
authors.forename: Aashish
authors.initials: A
authors.lastname: Patnaik
keywords: Endoscopic retrograde cholangiopancreaticography; laparoscopic cholecystectomy; rendezvous technique; sphincterotomy