Laparoendoscopic rendezvous versus laparoscopic antegrade sphincterotomy for choledocholithiasis

Background. The ideal management of common bile duct stones in the era of laparoscopic cholecystectomy is controversial. With rapid advances in technology and more experience in laparoscopic skills, many surgeons are now routinely performing single-stage procedures and questioning the wisdom of preoperative endoscopic retrograde cholangiopancreotography, with or without sphincterotomy. The purpose of this study was to compare the success rate, duration of operating time, clinical results, and duration of hospital stay of a laparoendoscopic rendezvous technique versus antegrade sphincterotomy in patients with cholerystitis-choledocholithiasis. Methods. Patients with gallbladder and common bile duct stones undergoing laparoscopic cholecystectomy plus retrograde sphincterotomy (group A; n = 35) were compared retrospectively with those undergoing laparoscopic cholecystectomy plus antegrade sphincterotomy (group B; n = 41) at a single institution. Results. Ductal stone clearance was equivalent in the 2 groups (94% vs 95%; P = .979), as was morbidity (9% vs 5%; P = .545) and conversion. (6% vs 5%; P = .877). The median operating time was less in group B (89 vs 117 minutes; P < .0001). There was no significant difference in hospital stay between the 2 groups (P = .140). Conclusion. This study suggests that intraoperative sphincterotomy with a combined endoscopic-laparoscopic approach for the removal of common bile duct stone(s) is safe and effective in routine surgical practice. Ductal stone(s) clearance, morbidity, and conversion were equivalent in the 2 groups; antegrade sphincterotomy had a shorter operative time compared with the rendezvous technique.