Systematic review and meta-analysis of intraoperative versus preoperative endoscopic sphincterotomy in patients with gallbladder and suspected common bile duct stones (Br J Surg 2011; 98: 908-916).

摘要

During laparoscopic cholecystectomy, placement of a guidewire through the cystic duct, common bile duct (CBD) and papilla into the duodenum facilitates endoscopic sphincterotomy (ES) ('rendezvous' technique). Mr Gurusamy and co-workers performed a meta-analysis of four randomized controlled trials, combining data from some 532 patients, on the outcome after preoperative ES (POES) versus intraoperative ES (IOES) during cholecystectomy in patients with suspected CBD stones. Advantages of IOES were reduced morbidity (3-4 versus 9-3 per cent), especially less post-ES pancreatitis, shorter hospital stay (3 days) and reduced costs (353 euros). The main disadvantage of IOES was a 30-45-min longer operating time. There were no differences in conversions, open bile duct explorations or mortality.