Meta-analysis of laparoscopic transcystic versus transcholedochal common bile duct exploration for choledocholithiasis

Background: It is not clear whether laparoscopic transcystic exploration (LTCE) laparoscopic choledochotomy (LCD) is superior in the management of choledocholithiasis. In this meta-analysis, the success of LTCE versus LCD was evaluated. Methods: Cochrane Central Register of Controlled Trials, Web of Science, Trip, PubMed, Ovid and Embase databases were searched systematically for relevant literature up to May 2017. Studies that compared the success rate of LTCE and LCD in patients with choledocholithiasis were included. PRISMA guidelines were followed. Multiple independent reviewers contributed on a cloud-based platform. Random-effects model was used to calculate odds ratios (ORs) or standardized mean differences (MDs) with 95 per cent confidence intervals. An a priori hypothesis was generated based on clinical experience that LTCE is as successful as LCD. Results: Of 3533 screened articles, 25 studies comprising 4224 patients were included. LTCE achieved a lower duct clearance rate than LCD (OR 0.38, 95 per cent c.i. 0.24 to 0.59). It was associated with a shorter duration of surgery (MD -0.86, 95 per cent c.i. -0.97 to -0.77), lower bile leak (OR 0.46, 0.23 to 0.93) and shorter hospital stay (MD -0.78, -1.14 to -0.42) than LCD. There was no statistically significant difference in conversion, stricture formation or reintervention rate. Conclusion: LCD has a higher rate of successful duct clearance, but is associated with a longer duration of surgery and hospital stay, and a higher bile leak rate.