Two-stage vs single-stage management for concomitant gallstones and common bile duct stones.
AIM
To evaluate the safety and effectiveness of two-stage vs single-stage management for concomitant gallstones and common bile duct stones.


METHODS
Four databases, including PubMed, Embase, the Cochrane Central Register of Controlled Trials and the Science Citation Index up to September 2011, were searched to identify all randomized controlled trials (RCTs). Data were extracted from the studies by two independent reviewers. The primary outcomes were stone clearance from the common bile duct, postoperative morbidity and mortality. The secondary outcomes were conversion to other procedures, number of procedures per patient, length of hospital stay, total operative time, hospitalization charges, patient acceptance and quality of life scores.


RESULTS
Seven eligible RCTs [five trials (n = 621) comparing preoperative endoscopic retrograde cholangiopancreatography (ERCP)/endoscopic sphincterotomy (EST) + laparoscopic cholecystectomy (LC) with LC + laparoscopic common bile duct exploration (LCBDE); two trials (n = 166) comparing postoperative ERCP/EST + LC with LC + LCBDE], composed of 787 patients in total, were included in the final analysis. The meta-analysis detected no statistically significant difference between the two groups in stone clearance from the common bile duct [risk ratios (RR) = -0.10, 95% confidence intervals (CI): -0.24 to 0.04, P = 0.17], postoperative morbidity (RR = 0.79, 95% CI: 0.58 to 1.10, P = 0.16), mortality (RR = 2.19, 95% CI: 0.33 to 14.67, P = 0.42), conversion to other procedures (RR = 1.21, 95% CI: 0.54 to 2.70, P = 0.39), length of hospital stay (MD = 0.99, 95% CI: -1.59 to 3.57, P = 0.45), total operative time (MD = 12.14, 95% CI: -1.83 to 26.10, P = 0.09). Two-stage (LC + ERCP/EST) management clearly required more procedures per patient than single-stage (LC + LCBDE) management.


CONCLUSION
Single-stage management is equivalent to two-stage management but requires fewer procedures. However, patient's condition, operator's expertise and local resources should be taken into account in making treatment decisions.
['Lu|Jiong|J|', 'Cheng|Yao|Y|', 'Xiong|Xian-Ze|XZ|', 'Lin|Yi-Xin|YX|', 'Wu|Si-Jia|SJ|', 'Cheng|Nan-Sheng|NS|']
D016009:Chi-Square Distribution D002681:China D002760:Cholangiopancreatography, Endoscopic Retrograde D017081:Cholecystectomy, Laparoscopic D042883:Choledocholithiasis D019317:Evidence-Based Medicine D042882:Gallstones D006801:Humans D007902:Length of Stay D016017:Odds Ratio D018579:Patient Selection D011183:Postoperative Complications D016032:Randomized Controlled Trials as Topic D018570:Risk Assessment D012307:Risk Factors D016717:Sphincterotomy, Endoscopic D013997:Time Factors D016896:Treatment Outcome
Gallstones Common bile duct stones Endoscopic retrograde cholangiopancreatography Laparoscopic cholecystectomy Laparoscopic common bile duct exploration Meta-analysis Endoscopic sphincterotomy