Laparoendoscopic Rendezvous for Concomitant Gall Bladder Stones and Common Bile Duct Stones
Laparoendoscopic Rendezvous for Difficult Cholecystocholedocholithiasis.
Minia University
80 participants
Jun 15, 2025
INTERVENTIONAL
Conditions
Summary
Chronic calculous cholecystitis in pediatric patients leads to choledocholithiasis in about 12% of cases. These patients require removal of stones from the common bile duct. The most common method of cleaning the common bile duct is endoscopic retrograde cholangiopancreatography, and the standard technique for removing the gallbladder is laparoscopic cholecystectomy. There are different approaches to the treatment of this category of patients: laparoscopic common bile duct exploration (LCBDE), laparoendoscopic rendezvous method (LERV) and one-stage LC( laparoscopic cholecystectomy) after ERCP( endoscopic retrograde cholangiopancreatography). The aim of this prospective study is to evaluate the efficacy and safety Laparoendoscopic rendezvous for difficult cholecystocholedocholithiasis.
Eligibility
Inclusion Criteria4
- Patients having stone(s) in the gallbladder and concurrent common bile duct , as determined by MRCP(magnetic resonance cholangiopancreatography) or US.
- Patients with acute cholecystitis, acute cholangitis, obstructive jaundice, and those with highly suspicious criteria for common bile duct stones, such as dilated CBD( common bile duct ) on US examination \> 7 mm in diameter without obvious common bile duct stones, high serum bilirubin level, and/or high serum alkaline phosphatase level, were also included in this study. (high risk for cholecystocholedocholithiasis)
- Previous failed ERCP attempt
- Patients fit for general anesthesia and tolerant of pneumoperitoneum and endoscopic procedures.
Exclusion Criteria12
- History of hepatobiliary surgery as choledochoduodenal anastomosis
- A Previous upper abdominal surgery as total or partial gastric resection.
- Morbid obesity.
- Uncorrectable coagulopathy.
- Patients who refused to give consent.
- Pregnancy.
- Suspected malignant biliary stricture or cholangiocarcinoma
- Severe acute cholangitis with hemodynamic instability or septic shock requiring immediate biliary drainage (may necessitate emergent ERCP or percutaneous drainage first)
- Impacted CBD stones or stones deemed too large for endoscopic extraction (e.g., \> 1.5 cm)
- Severe cardiopulmonary disease significantly increasing operative risk.
- Intrahepatic bile duct stones with indications for surgery.
- Patients with choledocholithiasis \>2 cm or a large number of stones were difficult to remove.
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Interventions
The main principles of LERV technique consists of 1. An antegrade trans cystic cannulation of the bile duct during laparoscopic cholecystectomy, with a guidewire that can be retrieved with a duodenoscope, thus facilitating retrograde bile duct cannulation. 2. An over-the-wire sphincterotome is then inserted and standard maneuvers of endoscopic common bile duct stones clearance are performed. 3. The procedure is then completed by cholecystectomy in one procedure
Locations(1)
View Full Details on ClinicalTrials.gov
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NCT07008170