Two Institutes Experience in Laparo-Endoscopic Rendezvous Technique for Gallbladder and Bile Duct Stones
Condition: Calculus; Gallbladder, With Cholecystitis
MeSH terms: Cholecystitis; Cholecystolithiasis; Gallstones; Calculi
Study type: Interventional

Summary: 
      The management of gallbladder stones (lithiasis) concomitant with bile duct stones is
      controversial. The management of CBD stones has evolved considerably since the advent of
      laparoscopic surgery. The more frequent approach is a two-stage procedure, with endoscopic
      sphincterotomy and stone removal from the bile duct followed by laparoscopic cholecystectomy.
      The laparoscopic-endoscopic rendezvous combines the two techniques in a single-stage
      operation. So the aim of this study was was to evaluate one-stage LC with intra-operative
      endoscopic sphincterotomy (IOES) vs two-stage pre-operative endoscopic sphincterotomy (POES)
      followed by LC for the treatment of cholecystocholedocholithiasis.
    

Detailed description: 
      This is two center study was carried out on 523 patients and completed in 436 patients with
      gall bladder stones and with suspected or confirmed CBDS at two gastroenterology center at
      zagazig first 264 patients at the Gastrointestinal Surgery Unit in the Zagazig University
      Hospitals and second 172 patients at gastroenterology unite at AL AHRAR hospital from January
      2010 till April 2022. A single-step technique combining LC and IO-ERCP was used to treat
      them. To confirm the presence of CBDS, a laparoscopic intraoperative cholangiography (IOC)
      was performed. A soft-tipped guidewire was inserted into the duodenum through the cystic duct
      and papilla. Over the guide-wire, an endoscopic papillotomy was introduced. The stones were
      retrieved with a retrieval balloon after an IO-ERCP and endoscopic sphincterotomy. The length
      of the postoperative hospital stay, surgical operating time, surgical success rate,
      postoperative complications, and residual CBDS were all evaluated. 77 patients excluded
      either incomplete data or didn't complete both steps within our centers.
    

Intervention name(s): The intraoperative ERCP has been performed immediately before LC; POES followed by LC
Intervention type(s): Procedure; Procedure
Intervention description(s): combination approach has been used to improve patient compliance and shorten hospital stays. The intraoperative ERCP has been performed immediately before Laparoscopic Cholecystectomy; Treatment in two stages, which combines a preoperative ES followed by LC (sequential treatment).
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: This study was carried out on 432 patients with gall bladder stones and with suspected or confirmed CBDS at two centers 264 patients at the Gastrointestinal Surgery Unit in the Zagazig University Hospitals and 168 patients at gastroenterology surgery unite at ALAHRAR hospitals from January 2010 till May 2022. Patients were randomized divided into two equally groups, the first group was treated by a single-step procedure combining LC and IOES while the second (control) group was treated by 2-stage (sequential treatment) POES followed by LC.
Masking: Double (Participant, Care Provider)
Primary purpose: Other