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Erschienen in:

16.04.2019 | Scientific Review

Laparoscopic Transcystic Versus Transductal Common Bile Duct Exploration: A Systematic Review and Meta-analysis

verfasst von: Shahin Hajibandeh, Shahab Hajibandeh, Diwakar Ryali Sarma, Sankar Balakrishnan, Mokhtar Eltair, Rajnish Mankotia, Misra Budhoo, Yogesh Kumar

Erschienen in: World Journal of Surgery | Ausgabe 8/2019

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Abstract

Objective

To evaluate comparative outcomes of laparoscopic transcystic (TC) and transductal (TD) common bile duct (CBD) exploration.

Methods

We systematically searched MEDLINE, EMBASE, CINAHL, CENTRAL, the World Health Organization International Clinical Trials Registry, ClinicalTrials.gov, ISRCTN Register, and bibliographic reference lists. CBD clearance rate, perioperative complications, and biliary complications were defined as the primary outcome parameters. Procedure time, length of hospital stay, conversion to open procedure were the secondary outcomes. Combined overall effect sizes were calculated using random-effects models.

Results

We identified 30 studies reporting a total of 4073 patients comparing outcomes of laparoscopic TC (n = 2176) and TD (N = 1897) CBD exploration. The TC approach was associated with significantly lower overall complications (RD: −0.07, P = 0.001), biliary complications (RD: −0.05, P = 0.0003), and blood loss (MD: −16.20, P = 0.02) compared to TD approach. Moreover, the TC approach significantly reduced the length of hospital stay (MD: −2.62, P < 0.00001) and procedure time (MD: −12.73, P = 0.005). However, there was no significant difference in rate of CBD clearance (RD: 0.00, P = 0.77) and conversion to open procedure (RD: 0.00, P = 0.86) between two groups.

Conclusions

Laparoscopic TC CBD exploration is safe and reduces overall morbidity and biliary complications compared to the TD approach. Moreover, it is associated with significantly shorter length of hospital stay and procedure time. High-quality randomised trials may provide stronger evidence with respect to impact of the cystic duct/CBD diameter, number or size of CBD stones, or cystic duct anatomy on the comparative outcomes of TC and TD approaches.

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Titel: Laparoscopic Transcystic Versus Transductal Common Bile Duct Exploration: A Systematic Review and Meta-analysis
verfasst von: Shahin Hajibandeh
Shahab Hajibandeh
Diwakar Ryali Sarma
Sankar Balakrishnan
Mokhtar Eltair
Rajnish Mankotia
Misra Budhoo
Yogesh Kumar
Publikationsdatum: 16.04.2019
Verlag: Springer International Publishing
Erschienen in: World Journal of Surgery / Ausgabe 8/2019
Print ISSN: 0364-2313
Elektronische ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-019-05005-y

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