Laparoscopic Cholecystectomy and Endoscopic Retrograde Cholangiopancreatography (ERCP) in a One-Step Procedure in Comparison to the Standard Two-Step Procedure: A Systematic Review and Meta-Analysis

Document Type : Original Article

Authors

Department of General Surgery, Faculty of Medicine, Ain Shams University, Egypt

Abstract

Background: Current treatment of complicated calculous biliary disease typically involves a two-step procedure
consisting of preoperative endoscopic retrograde cholangiopancreatography (ERCP) with or without CBD stents
followed by laparoscopic cholecystectomy a few weeks later.
Aim and objectives: The aim of this study was to perform a systematic review & meta-analysis to study the effect
of undergoing laparoscopic cholecystectomy and endoscopic retrograde cholangiopancreatography (ERCP) in the
same session versus different sessions.
Patients and methods: This is a systematic review & meta-analysis. A total of 1054 citations were obtained for
title and abstract review. Of the 1054 citations, 118 duplicates were removed with the Endnote X5 software, and
926 irrelevant studies were excluded by scanning the titles and abstracts. Full texts of the remaining 10 eligible
studies were retrieved for review.
Results: Mean Total cost per patient was 45,157.15 US Dollars (USD) in single stage vs 52,486.6 USD in two
stages group, ERCP success was 335\351 (95.4%) in single stage vs 528\572 (92.3%) in two stage group, failure
was found in 7\243 (2.8%) in single stage vs 13\347 (3.7%) two stage group and repeat ERCP required in 4\336
(1.2%) in one stage group while 17/342 (4.9%) in two stage group. Bile leak found in 8\325 (2.5%) single stage
vs 7\428 (1.6%) in two stage groups.
Conclusion: The present meta-analysis showed that combining Laparoscopic Cholecystectomy and Endoscopic
Retrograde Cholangiopancreatography (ERCP) in a one-step procedure had the advantages of shorter procedural
duration, less hospital stay, lower cost and lower complication rate in comparison to two stage procedure, however
both stage procedures have similar success rates. Another advantage of the one-stage procedure is clearing the
CBD and removing the gall bladder at the same time so CBD stents would not be required to be inserted and
removed in another session later. However, one-stage procedure is not feasible in all hospitals due to required
preparations of the Operations Room in contrast to the two-stage procedure.

Keywords

Ain Shams Journal of Surgery
Volume 16, Issue 4
October 2023
Pages 312-324

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