Meta-analysis of endoscopy and surgery versus surgery alone for common bile duct stones with the gallbladder in situ (Br J Surg 2006; 93; 1185-1191).

摘要

We read with great interest the meta-analysis by Clayton et al., in which the authors compared the effect of surgery alone versus ERCP with or without choiecystectomy for common bile duct stones. The reader is left with the conclusion that ERCP before or after choiecystectomy is an equivalent option to single-stage choiecystectomy with common bile duct clearance, and that the choice between them should be based upon local preferences. This is an oversimplification. In a recent Cochrane review, based upon almost the same references as used by Clayton et al., separate analyses were made for open and laparoscopic choiecystectomy. Open choiecystectomy with open bile duct surgery was significantly superior to ERCP in achieving bile duct stone clearance, whereas laparoscopic choiecystectomy with simultaneous bile duct exploration seemed to be as safe and as efficient as ERCP with the avoidance of an extra procedure.