ABSTRACT
Background: Choledocholithiasis or the presence of common bile duct stones [CBDS] is one of the medical conditions that requires surgical intervention
The management of Choledocholithiasis has evolved from open common bile duct exploration [OCBDE] to therapeutic endoscopic retrograde cholangiopancreatography [ERCP] to laparoscopic common bile duct exploration [LCBDE]. Each entails a degree of difficulty. In this review we aim to assess and compare the benefits and pitfalls of open surgery [OCBDE] versus endoscopic retrograde cholangiopancreatography [ERCP] in management of common bile duct stones
Methods: A systematic review of the electronically searched publications of the scientific literature. We searched the Cochrane HepatoBiliary Group Controlled Trials Register, Cochrane Central Register of Controlled Trials in The Cochrane Library, MEDLINE [1946 to 2016], EMBASE [1974 to 2016], and Science Citation Index Expanded [1900 to 2016]. Initially all randomized clinical trials which compared the results from open surgery versus endoscopic clearance for common bile duct stones were included, articles were selectively screened according to the eligibility criteria
Results: eight publications were selectively included with 761 participants compared to open surgical clearance with ERCP. All trials had a high risk of bias. There was no significant difference in the mortality between open surgery versus ERCP clearance [eight trials; 733 participants; 5/371 [1%] versus 10/358 [3%] OR 0.51;95% CI 0.18 to 1.44]. Neither was there a significant difference in the morbidity between open surgery versus ERCP clearance [eight trials; 733 participants; 76/371 [20%] versus 67/358 [19%] OR 1.12; 95% CI 0.77 to 1.62]
Participants in the open surgery group had significantly fewer retained stones compared with the ERCP group [seven trials; 609 participants; 20/313 [6%] versus 47/296 [16%] OR 0.36; 95% CI 0.21 to 0.62], P = 0.0002. Meta-analysis of the outcomes duration of hospital stay, quality of life, and cost of the procedures could not be performed due to lack of data
Conclusion: open surgery intervention in order to remove the gallbladder and trapped gallstones appears to be as safe as endoscopy and further suggested to be more successful than the endoscopic technique in clearing the duct stones