Ann Ital Chir. 2021;92:260-267.
The management of cholelithiasis and choledocholithiasis combined is controversial. The more frequent approach is a two-stage procedure, with endoscopic sphincterotomy and stone removal from the bile duct followed by laparoscopic cholecystectomy. This study aims to demonstrate how, on the basis of the personal experience, the Rendez-vous technique, that combines the two techniques in a single-stage operation is better than the sequential treatment.
Between June 2017 to December 2019, 40 consecutive patients with cholelithiasis and choledocholithiasis combined were enrolled for the study: 20 were treated with the sequential treatment and 20 with the Rendez-vous method. The preoperative diagnostic work-up was similar in the two group. The endpoints of the study included incidence of endoscopic and surgical complications, rate of hospitalization and cost analysis.
The study showed no difference in demographic parameters between the two groups, but the success rate of clearance of CBD was significantly smaller for sequential arm, with the need of additional procedures. We found a statistical reduction of postoperative acute pancreatitis, hospital stay and charges in Rendez-vous group, at the expense of a prolonged total operating time.
The data of the study confirm the superiority of the Rendez-vous technique because it resolves cholelithiasis associated with choledocholithiasis in a single surgical act, with greater acceptance of the patient who avoids a second invasive surgical act, and with a reduction in complications; moreover, it requires shorter hospitalization, resulting in reduced costs. We propose this option in the management of cases where preoperative ERCP-ES has failed.
Common bile duct stones, Cholecysto-choledocholithiasis, Endoscopic retrograde cholangiopancreatography, Endoscopic sphincterotomy, Laparoscopic cholecystectomy, Laparo-endoscopic Rendez-vous.
胆石症和胆总管结石合并症的治疗存在争议。更常见的方法是两阶段手术，先进行内镜下括约肌切开术和胆管取石术，然后再进行腹腔镜胆囊切除术。本研究旨在展示基于个人经验，将两种技术结合在一个阶段操作的 rendez-vous 技术如何优于序贯治疗。
在 2017 年 6 月至 2019 年 12 月期间，共有 40 例胆石症和胆总管结石合并症患者入组本研究：20 例采用序贯治疗，20 例采用 rendez-vous 法。两组的术前诊断检查相似。研究的终点包括内镜和手术并发症的发生率、住院率和成本分析。
研究结果显示，两组患者的人口统计学参数无差异，但序贯组清除 CBD 的成功率明显较低，需要额外的手术。我们发现 rendez-vous 组术后急性胰腺炎、住院时间和费用均有统计学减少，但总手术时间延长。
本研究的数据证实了 rendez-vous 技术的优越性，因为它可以在一次手术中解决与胆石症相关的胆总管结石，患者接受度更高，避免了第二次侵入性手术，并且减少了并发症；此外，它需要更短的住院时间，从而降低了成本。我们建议在术前 ERCP-ES 失败的情况下采用这种治疗方法。
胆总管结石；胆石症；胆总管结石；内镜逆行胰胆管造影术；内镜下括约肌切开术；腹腔镜胆囊切除术；腹腔镜内镜 rendez-vous。
