Is Laparoscopic Common Bile Duct Exploration Safe in Patients with Acute Cholangitis Caused by Common Bile Duct Stones? Results of a Systematic Review.

Abstract

Introduction: The traditional method of performing open common bile duct exploration (OCBDE) was replaced by a less invasive procedure known as laparoscopic common bile duct exploration (LCBDE) in elective surgery. But at present, the application of this technique is considered novel and controversial to treat acute cholangitis (AC). The aim of our systematic review was to investigate the safety and efficacy of laparoscopic surgery in patients with AC. Methods: Studies containing information on patients diagnosed with AC who underwent LCBDE were included. A search for relevant articles was carried out, in the Cochrane Library, PubMed, and Google Scholar databases. All studies included in the systematic review were assessed using the Newcastle-Ottawa Quality Assessment Scale. Results: A total of 10 studies were included. Seven were retrospective and three were prospective. Only one was a randomized controlled trial. There were three studies that compared elective LCBDE and emergency LCBDE. Two studies compared between primary closure and T-tube drainage. Two other studies focused on the comparison between LCBDE and OCBDE. One study examined the comparison of LCBDE and endoscopic retrograde cholangiopancreatography. Another study addressed the issue of conversion in LCBDE. One study compared early and delayed LCBDE. Conversion rates ranged from 0% to 16.92%. Morbidity ranged from 0% to 26.3%, and mortality ranged from 0% to 3.07%. There was no difference in terms of retained, residual, or recurrent stones, bile leak, hemorrhage, and postoperative pancreatitis, and this, comparing the different groups of patients. Bile duct and intestinal injuries as well as biliary stricture were not common. The average length of hospital stays was approximately 5.86 days, ranging from 2 to 11.12 days. Conclusion: The one-stage urgent LCBDE, while subject to debate, proves to be a secure, feasible, approach for managing nonsevere AC.