Meta-analysis of one- vs. two-stage laparoscopic/endoscopic management of common bile duct stones

Abstract

Background: The present study is a meta-analysis of English articles comparing one-stage [laparoscopic common bile duct exploration or intra-operative endoscopic retrograde cholangiopancreatography (ERCP)] vs. two-stage (laparoscopic cholecystectomy preceded or followed by ERCP) management of common bile duct stones.

Methods: MEDLINE/PubMed and Science Citation Index databases (1990-2011) were searched for randomized, controlled trials that met the inclusion criteria for data extraction. Outcomes were calculated as odds ratios (ORs) with 95% confidence intervals (CIs) using RevMan 5.1.

Results: Nine trials with 933 patients were studied. No significant differences was observed between the two groups with regard to bile duct clearance (OR, 0.89; 95% CI, 0.65-1.21), mortality (OR, 1.2; 95% CI, 0.32-4.52), total morbidity (OR, 0.75; 95% CI, 0.53-1.06), major morbidity (OR, 0.95; 95% CI, 0.60-1.52) and the need for additional procedures (OR, 1.58; 95% CI, 0.76-3.30).

Conclusions: Outcomes after one-stage laparoscopic/endoscopic management of bile duct stones are no different to the outcomes after two-stage management.

© 2012 International Hepato-Pancreato-Biliary Association.

Figures

Figure 1

Flow chart of the selection of studies eligible for data extraction and analysis

Figure 2

Meta-analysis of successful bile duct clearance (fixed-effects model). Error bars indicate a 95% confidence interval (CI). A summary of effects is shown as a diamond that spans the 95% CI

Figure 3

Mortality (fixed-effects model). Error bars indicate a 95% confidence interval (CI). A summary of effects is shown as a diamond that spans the 95% CI

Figure 4

Morbidity (total) (fixed-effects model). Error bars indicate a 95% confidence interval (CI). A summary of effects is shown as a diamond that spans the 95% CI

Figure 5

Morbidity (major) (fixed-effects model). Error bars indicate a 95% confidence interval (CI). A summary of effects is shown as a diamond that spans the 95% CI

Figure 6

Additional procedures required (Random-effects model). Error bars indicate a 95% confidence interval (CI). A summary of effects is shown as a diamond that spans the 95% CI