Comparison On LCBDE+LC Vs ERCP/EST+LC For The Treatment Of Concomitant Cholecystolithiasis And Choledocholithiasis.A Meta-analysis Of Randomized Controlled Trials

Objective: Laparoscopic common bile duct exploration(LCBDE)joint laparoscopic cholecystectomy(LC)and endoscopic retrograde cholangiopancreatography / endoscopic sphincterotomy(ERCP / EST)combined laparoscopic cholecystectomy are the two main minimally invasive surgical procedures to treat concomitant gallstones and common bile duct stones in clinical,currently.However,it’s as yet undefined which surgical procedure represents a significant advantage.This study evaluated the therapeutic efficacy and safety of the two surgical options in concomitant cholecystolithiasis and choledocholithiasis patient.Methods: Retrieving Pub Med,Cochrane Library,MEDLINE,Wang Fang,CNKI databases to look for research studies which are issued on randomized controlled trial about comparison of clinical efficacy and safety among the above two surgical options until August 1th,2019.In accordance with established inclusion and exclusion criteria by two independent personnel selecting and screening documents and extracting information on the included studies using GRADE risk bias assessment tools.We used Rev Man 5.3 for Meta-analysis.Results: A total of 15 randomized controlled trials(RCTs)were included in this study,involving 2115 patients:(1072 in the pure laparoscopic surgery group versus 1043 in the other).The results of meta-analysis showed that the time of operation[MD=-25.13,95%CI(-50.13,-0.12),P=0.05] and the hospitalization time[MD=-1.66,95%CI(-2.59,-0.73),P=0.0005] in the LCBDE+ LC group was Shorter than that in the other group,the LCBDE+ LC group also had lower hospitalization costs.Furthermore,the other group was more tend to postoperative pancreatitis [OR=0.25,95%CI(0.12,0.53),P=0.0003] and bleeding[OR=0.33,95%CI(0.12,0.87),P=0.02].Compared to the LCBDE+ LC group,the incidence of postoperative biliary leakage in the other group was lower[OR=4.29,95%CI(1.97,9.36),P=0.0003].There was no significant difference between the two groups in the aspect of total incidence of complications,mortality rate,stone removal rate and the rate of open operation midway.Conclusion: The data analysis results showed that the total complication rate,mortality rate,stone removal rate and the rate of open operation midway in the two groups were not significantly different.However,the pure laparoscopic surgery group had a higher incidence of biliary leakage,while the other was more tend to occur postoperative pancreatitis and bleeding.Besides,the pure laparoscopic surgery group is superior to the other group in terms of operation time and the hospitalization time and costs.However,due to the uneven quality of included literatures and other factors,the above conclusions still need to be further verified by larger sample RCTs in the future.