title: Systematic review and meta-analysis of minimally invasive techniques for the management of cholecysto-choledocholithiasis.
abstract: BACKGROUND
  The optimal management of patients with symptomatic gallstones and possible or proven common bile duct (CBD) stones and gallstones is still evolving. Today a number of options exist: preoperative endoscopic retrograde cholangiopancreatography (pre-op ERCP), laparoscopic cholecystectomy (LC) combined with intraoperative endoscopic sphincterotomy (IOES), laparoscopic common bile duct exploration (LCBDE) and postoperative ERCP (post-op ERCP). This meta-analysis was done to compare these management options and determine if any single option was clearly superior.
  
  
  METHODS
  A systematic search was conducted using several electronic databases. The search revealed 15 randomized controlled trials (RCTs). Six comparing pre-op ERCP with LCBDE, five comparing pre-op ERCP with IOES, two comparing IOES with LCBDE and two comparing post-op ERCP with LCBDE, comprising a total of 1992 patients.
  
  
  RESULTS
  The pre-op ERCP group had a significantly higher incidence of ERCP related complications (odds ratio: 2.40, 95% confidence interval: 1.21-4.75).
  
  
  CONCLUSIONS
  The evidence provided by this meta-analysis suggests that both of these approaches would appear comparable. To fully address which would be the better approach would require an RCT as discussed above.
authors.affiliation: The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney Nepean Hospital, Level 5, South Block, P.O. Box 63, Penrith, NSW, 2751, Australia.
authors.forename: Vinayak
authors.initials: V
authors.lastname: Nagaraja
authors.forename: Guy D
authors.initials: GD
authors.lastname: Eslick
authors.forename: Michael R
authors.initials: MR
authors.lastname: Cox
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde; D041761:Cholecystolithiasis / Q000601:surgery*; D042883:Choledocholithiasis / Q000601:surgery*; D013505:Digestive System Surgical Procedures; D006801:Humans; D019060:Minimally Invasive Surgical Procedures; D011183:Postoperative Complications
keywords: Endoscopic retrograde cholangiopancreatography; Laparoscopic cholecystectomy; Laparoscopic common bile duct exploration; Laparoscopic transcystic common bile duct exploration