OBJECTIVE:
To assess the safety and efficacy of one-step surgical interventions using the “rendezvous” technique in patients with acute and chronic (exacerbated) calculous cholecystitis complicated by choledocholithiasis.
METHODS:
A meta-analysis of randomized controlled trials (RCTs) was conducted using studies retrieved from the PubMed and eLibrary databases. The analysis compared the outcomes of procedures performed using the «rendezvous» technique (simultaneous laparoscopic cholecystectomy and endoscopic transpapillary interventions within a single operation) with two-stage procedures (sequential endoscopic transpapillary interventions followed by laparoscopic cholecystectomy). The primary endpoints included the incidence of specific postoperative complications (acute post-manipulative pancreatitis, cholangitis, biliary peritonitis, and bleeding from the major duodenal papilla), mortality rates, and length of hospitalization.
Statistical analysis was performed using the R programming language and the «meta» software package. Heterogeneity among included studies was assessed using the Q-test and the I² and tau² statistics. The risk of publication bias was evaluated using Funnel Plot analysis with Trim and Fill correction. The meta-analysis was conducted using a random-effects model.
RESULTS:
Ten RCTs, comprising data from 1.492 patients diagnosed with acute or chronic (exacerbated) calculous cholecystitis complicated by choledocholithiasis, were included in the meta-analysis. Among them, 741 patients (49.7%) underwent one-step procedures using the “rendezvous” technique, while 751 patients (50.3%) underwent two-stage procedures.
Patients who underwent the “rendezvous” approach demonstrated a significant reduction in the overall incidence of specific postoperative complications (RR: 0.63, CI: 0.45—0.90, p=0.0097), particularly acute post-manipulative pancreatitis (RR: 0.54, CI: 0.32—0.91, p=0.0223), as well as a shorter hospital stay (MD: -3.0912, CI: -3.5653 to -2.6171, p<0.0001) compared to those who underwent two-stage procedures. However, a statistically significant difference in mortality rates between the study groups could not be determined.
CONCLUSION:
One-step surgical interventions using the “rendezvous” technique in patients with acute and chronic calculous cholecystitis complicated by choledocholithiasis represent a safe and effective minimally invasive approach to surgical treatment. This technique significantly reduces the incidence of specific postoperative complications and shortens hospitalization duration.
