Randomized clinical trial of intraoperative endoscopic retrograde cholangiopancreatography versus laparoscopic bile duct exploration in patients with choledocholithiasis.
BACKGROUND
Various minimally invasive approaches exist for the management of choledocholithiasis at the time of laparoscopic cholecystectomy. The aim of this study was to compare endoscopic retrograde cholangiopancreatography (ERCP) with laparoscopic bile duct exploration (LBDE) and test the hypothesis that intraoperative ERCP is no different to LBDE in terms of rate of bile duct clearance or retained stones.


METHODS
Eligible patients with choledocholithiasis undergoing emergency laparoscopic cholecystectomy were randomized to intraoperative ERCP or LBDE in a 1 : 1 ratio. The primary outcomes were rates of bile duct clearance and retained stones. Secondary outcomes were postprocedure complication rate, mortality rate, postoperative length of hospital stay, conversion to open surgery rate, procedural time and total duration of surgery.


RESULTS
Some 104 patients were randomized, and 52 patients in each group were included in an intention-to-treat analysis. Duct clearance rates were 87 per cent for patients who had intraoperative ERCP and 69 per cent for those in the LBDE group (P = 0·057). The rate of retained stones was lower in the ERCP group than in the LBDE group: 15 versus 42 per cent respectively (P = 0·004). Median postoperative length of stay was shorter with ERCP (2 days versus 3 days for LBDE; P = 0·015).


CONCLUSIONS
Intraoperative ERCP is more effective than LBDE in terms of minimizing the rate of retained stones in patients with choledocholithiasis undergoing emergency laparoscopic cholecystectomy.


BACKGROUND
ACTRN12613000761763 (http://www.anzctr.org.au/).
Upper Gastrointestinal/Hepato-Pancreato-Biliary and General Surgery Unit, Monash University, Victoria, Australia.
B R
BR
Poh
Department of Surgery (School of Clinical Sciences at Monash Health), Monash University, Victoria, Australia.
S P S
SP
Ho
Upper Gastrointestinal/Hepato-Pancreato-Biliary and General Surgery Unit, Monash University, Victoria, Australia.
M
M
Sritharan
Upper Gastrointestinal/Hepato-Pancreato-Biliary and General Surgery Unit, Monash University, Victoria, Australia.
C C
CC
Yeong
Gastroenterology and Hepatology Unit, Monash Health, Monash University, Victoria, Australia.
M P
MP
Swan
Gastroenterology and Hepatology Unit, Monash Health, Monash University, Victoria, Australia.
D A
DA
Devonshire
Upper Gastrointestinal/Hepato-Pancreato-Biliary and General Surgery Unit, Monash University, Victoria, Australia.|Department of Surgery (School of Clinical Sciences at Monash Health), Monash University, Victoria, Australia.
P A
PA
Cashin
Upper Gastrointestinal/Hepato-Pancreato-Biliary and General Surgery Unit, Monash University, Victoria, Australia.|Department of Surgery (School of Clinical Sciences at Monash Health), Monash University, Victoria, Australia.
D G
DG
Croagh
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D042883:Choledocholithiasis / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult