A meta-analysis of single-stage versus two-stage management for concomitant gallstones and common bile duct stones.
OBJECTIVE
To conduct a randomized controlled trial (RCT) meta-analysis to evaluate the safety and effectiveness of single-stage [laparoscopic cholecystectomy (LC)+laparoscopic common bile duct exploration (LCBDE)] vs. two-stage management [preoperative endoscopic retrograde cholangiopancreatography (ERCP)+LC] for concomitant gallstones and common bile duct stones.


METHODS
RCTs that met the inclusion criteria for data extraction were identified from electronic databases (PubMed, Embase, Science Citation Index, and the Cochrane Library) up to August 2014. The relevant congressional proceedings were also searched. The primary outcomes were stone clearance from the common bile duct, postoperative morbidity and mortality. The secondary outcomes were conversion to other procedures, length of hospital stay, total operative time, and hospitalization charges. The outcomes were calculated as odds ratios (ORs) with 95% confidence intervals (CIs) using RevMan 5.2.


RESULTS
Eight RCTs, which included 1130 patients, were identified for analysis in our study. The meta-analysis revealed that the common bile duct stone clearance rate in the single-stage group was higher (OR=1.56, 95% CI: 1.05 to 2.33, P=0.03). The lengths of hospital stay (MD=-1.02, 95% CI: -1.99 to -0.04, P=0.04) and total operative times (MD=-16.78, 95% CI: -27.55 to -6.01, P=0.002) were also shorter in the single-stage group. There was no statistically significant difference between the two groups regarding postoperative morbidity (OR=1.12, 95% CI: 0.79 to 1.59, P=0.52), mortality (OR=0.29, 95% CI: 0.06 to 1.41, P=0.13) and conversion to other procedures (OR=0.82, 95% CI: 0.37 to 1.82, P=0.62).


CONCLUSIONS
Single- and two-stage management for cholecysto-choledocholithiasis had similar mortality and complication rates; however, the single-stage strategy was better in terms of stone clearance, hospital stay and total operative time.
Department of Biliary-Pancreatic Surgery, Ren Ji Hospital, School of Medcine, Shanghai Jiao Tong University, Shanghai 200127, China.
Hong-Yi
HY
Zhu
Department of Biliary-Pancreatic Surgery, Ren Ji Hospital, School of Medcine, Shanghai Jiao Tong University, Shanghai 200127, China.
Ming
M
Xu
Department of Biliary-Pancreatic Surgery, Ren Ji Hospital, School of Medcine, Shanghai Jiao Tong University, Shanghai 200127, China.
Huo-Jian
HJ
Shen
Department of Biliary-Pancreatic Surgery, Ren Ji Hospital, School of Medcine, Shanghai Jiao Tong University, Shanghai 200127, China.
Chao
C
Yang
Department of Biliary-Pancreatic Surgery, Ren Ji Hospital, School of Medcine, Shanghai Jiao Tong University, Shanghai 200127, China.
Fu
F
Li
Department of Biliary-Pancreatic Surgery, Ren Ji Hospital, School of Medcine, Shanghai Jiao Tong University, Shanghai 200127, China.
Ke-Wei
KW
Li
Department of Biliary-Pancreatic Surgery, Ren Ji Hospital, School of Medcine, Shanghai Jiao Tong University, Shanghai 200127, China.
Wei-Jin
WJ
Shi
Department of Biliary-Pancreatic Surgery, Ren Ji Hospital, School of Medcine, Shanghai Jiao Tong University, Shanghai 200127, China. Electronic address: jifu@renji.com.
Fu
F
Ji
D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D017081:Cholecystectomy, Laparoscopic; D041761:Cholecystolithiasis / Q000000981:diagnostic imaging* / Q000601:surgery*; D061887:Conversion to Open Surgery; D042882:Gallstones / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D061646:Operative Time; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome