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

We read with great interest the meta-analysis of intraoperative (IOES) versus preoperative endoscopic sphinctero-tomy in patients with gallbladder and suspected common bile duct stones by Gurusamy and colleagues. We trialled this approach in the early 1990s with the advent of laparoscopic cholecystec-tomy, and our initial experience was published. Our conclusions were similar but we have a few additional comments to make.As pointed out in the paper, IOES is performed in the supine rather than the usual prone position making the procedure more challenging. The availability of resources is important and our conclusion was that IOES would be feasible only in centres where the surgeon is also the endoscopist. It is not feasible in centres where it takes a significant amount of time to gather the expertise in the operating theatre with the patient already anaesthetized. In view of these difficulties it is no surprise that IOES has not gained popularity amongst surgeons. There is no doubt an advantage to the patient. Whether performed before or after operation endoscopic retrograde cholangiopancreatog-raphy (ERCP) can be an unpleasant experience, and having it under a general anaesthetic can be advantageous for the patient.