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Laparoscopic Transcystic Common Bile Duct Exploration: Advantages over Laparoscopic Choledochotomy

View Article: PubMed Central - PubMed

ABSTRACT

Purpose: The ideal treatment for choledocholithiasis should be simple, readily available, reliable, minimally invasive and cost-effective for patients. We performed this study to compare the benefits and drawbacks of different laparoscopic approaches (transcystic and choledochotomy) for removal of common bile duct stones.

Methods: A systematic search was implemented for relevant literature using Cochrane, PubMed, Ovid Medline, EMBASE and Wanfang databases. Both the fixed-effects and random-effects models were used to calculate the odds ratio (OR) or the mean difference (MD) with 95% confidence interval (CI) for this study.

Results: The meta-analysis included 18 trials involving 2,782 patients. There were no statistically significant differences between laparoscopic choledochotomy for common bile duct exploration (LCCBDE) (n = 1,222) and laparoscopic transcystic common bile duct exploration (LTCBDE) (n = 1,560) regarding stone clearance (OR 0.73, 95% CI 0.50–1.07; P = 0.11), conversion to other procedures (OR 0.62, 95% CI 0.21–1.79; P = 0.38), total morbidity (OR 1.65, 95% CI 0.92–2.96; P = 0.09), operative time (MD 12.34, 95% CI −0.10–24.78; P = 0.05), and blood loss (MD 1.95, 95% CI −9.56–13.46; P = 0.74). However, the LTCBDE group showed significantly better results for biliary morbidity (OR 4.25, 95% CI 2.30–7.85; P<0.001), hospital stay (MD 2.52, 95% CI 1.29–3.75; P<0.001), and hospital expenses (MD 0.30, 95% CI 0.23–0.37; P<0.001) than the LCCBDE group.

Conclusions: LTCBDE is safer than LCCBDE, and is the ideal treatment for common bile duct stones.

No MeSH data available.


Funnel plots for meta-analysis.A, Nine articles in the meta-analysis of biliary morbidity; B, 14 articles in the meta-analysis of length of hospital stay. C, Three articles in the meta-analysis of hospital expenses.
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pone.0162885.g004: Funnel plots for meta-analysis.A, Nine articles in the meta-analysis of biliary morbidity; B, 14 articles in the meta-analysis of length of hospital stay. C, Three articles in the meta-analysis of hospital expenses.

Mentions: In this meta-analysis, the funnel plot shapes for postoperative complications and postoperative biliary complications showed basic symmetry (Fig 4). No significant publication bias was observed. The results were similar and the combined results were highly reliable.


Laparoscopic Transcystic Common Bile Duct Exploration: Advantages over Laparoscopic Choledochotomy
Funnel plots for meta-analysis.A, Nine articles in the meta-analysis of biliary morbidity; B, 14 articles in the meta-analysis of length of hospital stay. C, Three articles in the meta-analysis of hospital expenses.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5036868&req=5

pone.0162885.g004: Funnel plots for meta-analysis.A, Nine articles in the meta-analysis of biliary morbidity; B, 14 articles in the meta-analysis of length of hospital stay. C, Three articles in the meta-analysis of hospital expenses.
Mentions: In this meta-analysis, the funnel plot shapes for postoperative complications and postoperative biliary complications showed basic symmetry (Fig 4). No significant publication bias was observed. The results were similar and the combined results were highly reliable.

View Article: PubMed Central - PubMed

ABSTRACT

Purpose: The ideal treatment for choledocholithiasis should be simple, readily available, reliable, minimally invasive and cost-effective for patients. We performed this study to compare the benefits and drawbacks of different laparoscopic approaches (transcystic and choledochotomy) for removal of common bile duct stones.

Methods: A systematic search was implemented for relevant literature using Cochrane, PubMed, Ovid Medline, EMBASE and Wanfang databases. Both the fixed-effects and random-effects models were used to calculate the odds ratio (OR) or the mean difference (MD) with 95% confidence interval (CI) for this study.

Results: The meta-analysis included 18 trials involving 2,782 patients. There were no statistically significant differences between laparoscopic choledochotomy for common bile duct exploration (LCCBDE) (n = 1,222) and laparoscopic transcystic common bile duct exploration (LTCBDE) (n = 1,560) regarding stone clearance (OR 0.73, 95% CI 0.50–1.07; P = 0.11), conversion to other procedures (OR 0.62, 95% CI 0.21–1.79; P = 0.38), total morbidity (OR 1.65, 95% CI 0.92–2.96; P = 0.09), operative time (MD 12.34, 95% CI −0.10–24.78; P = 0.05), and blood loss (MD 1.95, 95% CI −9.56–13.46; P = 0.74). However, the LTCBDE group showed significantly better results for biliary morbidity (OR 4.25, 95% CI 2.30–7.85; P<0.001), hospital stay (MD 2.52, 95% CI 1.29–3.75; P<0.001), and hospital expenses (MD 0.30, 95% CI 0.23–0.37; P<0.001) than the LCCBDE group.

Conclusions: LTCBDE is safer than LCCBDE, and is the ideal treatment for common bile duct stones.

No MeSH data available.