Clinical Outcomes and Safety of Ureteral Catheter-Assisted Antegrade Guidewire Intubation in the Laparoscopic-Endoscopic Rendezvous Procedure for Cholelithiasis with Choledocholithiasis: A Retrospective Cohort Study.

Abstract

Background and purpose: The laparoscopic-endoscopic rendezvous procedure, which integrates laparoscopic cholecystectomy with intraoperative endoscopic retrograde cholangiopancreatography (ERCP), is an established therapeutic strategy for patients with cholelithiasis and concomitant choledocholithiasis. This study evaluated the impact of ureteral catheter-assisted antegrade guidewire intubation on the procedural success rate and duration of the rendezvous technique, with additional assessment of safety and clinical efficacy.

Methods: Clinical data were retrospectively analyzed from patients with cholelithiasis and concomitant choledocholithiasis who underwent laparoscopic cholecystectomy at the South Campus of Taizhou Hospital (Enze Hospital), Zhejiang Province, between May 2019 and December 2022. A total of 116 patients were assigned to either a control group or an intervention group in which ureteral catheter-assisted guidewire insertion was employed.

Results: The success rate of antegrade guidewire intubation was 98.3% in the intervention group, compared to 91.2% in the control group. The intervention group demonstrated a statistically significant reduction in guidewire insertion time (p < 0.05). No statistically significant differences were observed between groups in terms of intraoperative hospitalization costs, total hospitalization duration, postoperative serum amylase levels or postoperative hospitalization duration (p > 0.05). The total operative duration tended to be lower but did not reach statistical significance in the intervention group compared to the control group, with a p-value of 0.054. No cases of postoperative bile leakage were reported. In the control group, the incidence of acute pancreatitis was 2%, and the incidence of hyperamylasemia was 28.8%. In the intervention group, hyperamylasemia occurred in 25.9% of cases, with no reported instances of acute pancreatitis. Additionally, one patient in the control group developed a pulmonary embolism, and two patients developed ascites accompanied by fever.

Conclusion: The use of ureteral catheter-assisted antegrade guidewire intubation during the laparoscopic-endoscopic rendezvous procedure appears to be a safe and clinically effective approach for managing cholelithiasis and concomitant choledocholithiasis. This technique is associated with a high success rate of guidewire realignment, reduced procedural duration, and a lower incidence of procedure-related complications.