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Laparoscopic Common Bile Duct Exploration Followed by Primary Suture Using a Modified Bile Duct Incision
Published on: May 2, 2025
Common bile duct stones management: A network meta-analysis
Shahin Mohseni1, Gary Alan Bass, Maximilian Peter Forssten
1From the Division of Trauma and Emergency Surgery, Department of Surgery (S.M., M.P.F.), Orebro University Hospital; School of Medical Sciences, Orebro University (S.M., G.A.B., M.P.F.), Orebro, Sweden; Division of Traumatology, Surgical Critical Care and Emergency Surgery (G.A.B.), Penn Presbyterian Medical Center, University of Pennsylvania, Philadelphia, Pennsylvania; Servicio de Cirugía General y Digestiva, Unidad de Cirugía de Urgencias y Trauma (I.M.C.), Hospital Universitario Virgen del Rocio, Sevilla, Andalucia, Spain; Division of Acute Care Surgery (M.M.), Los Angeles County + USC Medical Center, Uniformed Services University Health Sciences, Los Angeles, California; Division of General Surgery, Trauma, and Surgical Critical Care, Department of Surgery (K.A.D.), Yale School of Medicine, New Haven, Connecticut; Division of Acute Care Surgery, Department of Surgery (E.R.H.), Department of Anesthesiology and Critical Care Medicine (E.R.H.), and Department of Emergency Medicine (E.R.H.), The Johns Hopkins University School of Medicine; Department of Health Policy and Management (E.R.H.), The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Letterkenny Hospital (M.S.), Galway University, Galway, Ireland; UOSD Chirurgia d'Urgenza (H.K.), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Center of Trauma and Critical Care (B.S.), George Washington University, Washington, DC; Clinical Epidemiology and Biostatistics (Y.C.), School of Medical Sciences, Orebro University, Orebro, Sweden; Department of Surgery, Riverside University Health System Medical Center (R.C.); Department of Surgery, Loma Linda University School of Medicine (R.C.), Loma Linda; and Department of Surgery, Comparative Effectiveness and Clinical Outcomes Research Center (R.C.), California.
One-stage management of common bile duct (CBD) stones, including laparoscopic CBD exploration or intraoperative ERCP, reduces hospital stay and offers comparable outcomes to two-stage approaches.
Area of Science:
- Gastroenterology and Hepatobiliary Surgery
- Minimally Invasive Procedures
- Evidence-Based Medicine
Background:
- Optimal management of symptomatic common bile duct (CBD) stones in acute settings remains undefined.
- Systematic review and network meta-analysis comparing one-stage and two-stage procedures for CBD stones.
- Key outcomes include postprocedural complications and hospital length of stay (LOS).
Approach:
- Searched PubMed, SCOPUS, MEDLINE, Embase, and Cochrane from 2010-2021 for comparative studies.
- Included studies comparing at least two procedures for CBD stones, recording complications and LOS.
- Network meta-analysis conducted to compare four management approaches for CBD stones.
Key Points:
- 16 studies (8,644 participants) analyzed for LOS; 41 studies (19,756 participants) for complications.
- One-stage approaches significantly decreased LOS compared to two-stage approaches.
- CBD exploration showed lower overall complication risk than preoperative ERCP; specific complication differences noted.
Conclusions:
- Laparoscopic CBD exploration and intraoperative ERCP demonstrate equally good outcomes.
- One-stage approaches offer a preferable single-anesthesia pathway.
- One-stage management leads to a shorter overall hospital length of stay compared to two-stage methods.
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Assessment:
Endoscopic Procedures V: ERCP
Patient...

