Department of General Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy.
Department of Gastroenterology, Morgagni-Pierantoni Hospital, Forlì, Italy.
Surg Endosc. 2018 Sep;32(9):3868-3873. doi: 10.1007/s00464-018-6125-0. Epub 2018 Feb 27.
Although the ideal management of cholecysto-choledocholitiasis is controversial, the two-stage approach, namely the common bile duct (CBD) clearance through endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy, remains the standard way of management. However, whenever feasible, the one-stage approach, using the so-called "laparoendoscopic rendezvous" (LERV) technique, offers some advantages, mainly reducing the hospital stay and the risk of post-ERCP pancreatitis. The aim of this study was to evaluate the safety and the efficacy of the one-stage approach, and to compare our results with data from available large studies.
We reviewed our series of consecutive patients with cholecysto-choledocholitiasis treated by LERV from January 2003, to October 2016. Both elective and emergency cases were included. The primary end-point was the efficacy to obtain the CBD stones clearance. Secondary end-points were morbidity and mortality, operative time, conversion rate, and in-hospital stay.
A total of 200 patients underwent a LERV procedure for the intra-operative diagnosis by intra-operative cholangiogram of cholecysto-choledocholitiasis. In 187 patients (93.5%), it was possible to cannulate the cystic duct with the jag-wire. Success rate was 95%. Conversion rate was 3%. The mean operative time was 135 min and the mean in-hospital stay was 4 days. 29 (14.5%) were the early complications, six mild pancreatitis. Four patients required re-operation during the hospital stay. 11 patients (5.5%) developed late complications during a median follow-up of 57.7 months.
Our results confirm that LERV technique is a safe procedure with high success rates for the treatment of cholecysto-choledocholitiasis. The major advantages include the single-stage treatment, the shorter hospital stay, and the lower incidence of post-ERCP pancreatitis.
尽管胆石症的理想治疗方法存在争议，但两阶段方法，即通过内镜逆行胰胆管造影（ERCP）清除胆总管（CBD），然后进行腹腔镜胆囊切除术，仍然是标准的治疗方法。然而，只要可行，使用所谓的“腹腔镜内镜会合术”（LERV）技术的一阶段方法具有一些优势，主要是减少住院时间和 ERCP 后胰腺炎的风险。本研究旨在评估一阶段方法的安全性和疗效，并将我们的结果与现有大型研究的数据进行比较。
我们回顾了 2003 年 1 月至 2016 年 10 月期间，采用 LERV 治疗的连续胆石症患者系列。包括择期和急诊病例。主要终点是获得 CBD 结石清除的疗效。次要终点是发病率和死亡率、手术时间、转化率和住院时间。
共有 200 例患者因术中诊断为胆石症而行 LERV 手术，术中行胆管造影。在 187 例患者（93.5%）中，均能通过 Jag-wire 穿刺胆囊管。成功率为 95%。转化率为 3%。平均手术时间为 135 分钟，平均住院时间为 4 天。29 例（14.5%）发生早期并发症，6 例为轻度胰腺炎。4 例患者在住院期间需要再次手术。11 例（5.5%）在中位随访 57.7 个月期间发生晚期并发症。
我们的结果证实，LERV 技术是一种安全的治疗胆石症的方法，成功率高。主要优点包括单一阶段治疗、住院时间短、ERCP 后胰腺炎发生率低。
