Meta analysis of laparoscopic cholecystectomy combined with intra-operative endoscopic sphincterotomy for cholecysto-choledocholithiasis

Abstract:

Objective：To systematically evaluate the effectiveness of laparoscopic cholecystectomy（LC） combined with either intra-op－erative or preoperative endoscopic sphincterotomy（IOES or POES） in the treatment of cholecysto-choledocholithiasis. Methods：Cochrane Library，PubMed，EMbase and CBM data bases were searched to identify randomized controlled trials（RCTs） published between May 1990 and May 2012 in which the effectiveness of LC+IOES was compared with that of LC+POES. Meta analysis was performed using the software RevMan5.0. Results：Five RCTs with 631 patients were included. Meta analysis revealed that compared with those of LC+POES，LC+IOES significantly reduced the postoperative complication rate of endoscopic retrograde cholangio pan－creatography/sphincterotomy（ERCP/S）（RR=0.46，95%CI（0.24，0.88），P=0.02），especially that of acute pancreatitis（RR=0.21，95%CI（0.06，0.71），P=0.01）；shorten hospital duration（WMD=-2.13，95%CI（-2.70，-1.56），P<0.000 01） and reduced hospitalization cost（WMD=-352.61，95%CI（-637.18，-68.03），P=0.02）. There was no difference between the two groups regarding the successful rate of surgery（RR=1.00，95%CI（0.94，1.07），P=0.99）. Conclusion：LC+IOES is effective and safe in the treatment of cholecysto-choledo－cholithiasis and worth clinical promotion