Management of cholelithiasis with choledocholithiasis: Endoscopic and surgical approaches

Table 1 Factors that suggest the preference of the rendezvous technique over other treatments

Main indications for the laparo-endoscopic RV	RV preferable vs laparoscopic CBD exploration	RV preferable vs sequential ERCP-ES
(1) CBD stones not easily extractable	(A) Need of higher surgical skill	(a) Risk of synchronization
through the cystic duct	(B) Longer operation time	(b) Risk of unnecessary ERCP
Positive factor - > (time reduction)	(C) Need of biliary drain	(c) Risk of difficult retrograde
		cannulation
(2) Multiple small CBD stones and large friable stones	A, B, C +	a, b, c
Positive factor - > (reduction of risk of recurrence)	(D) High risk of residual fragments and recurrence
(3) Any type of CBD stones with delayed passage of the	A, B, C, D +	a, b, c
contrast medium during IOC or T-tube-IOC after	(E) High risk of undertreatment of chronic
laparoscopic CBD exploration	papillitis and of maintenance of underlying causes
Positive factor - > (reduction of risk of recurrence)
(4) CBD stones with previous cholangitis	A, B, C, D +	a, b, c +
Positive factor - > (reduction of risk of recurrence)	(E) High risk of maintenance of underlying causes	(d) Avoidance of contrast medium injection
	at the papilla	with risk of recurrence of cholangitis
(5) CBD stones after recurrent acute biliary pancreatitis	A, B, C, D, E	a, b, c, d +
or hyperbilirubinemia		(e) risk of recurrence of ERCP
Positive factor - > (iatrogenic risk reduction)		related acute pancreatitis
(6) Known or unsuspected sphincter of Oddi dysfunction,	A, B, C, D, E	a, b, c, d, e
cholecysto-lithiasis with or without CBD stones
Positive factor - > (iatrogenic risk reduction)
(7) CBD stones and/or abovementioned problems in patients	A, B, C, D, E +	a, b, c, d, e +
with Billroth Ⅱ during open cholecystectomy	(F) Manual drive of the endoscope by the surgeon	(f) more difficult ERCP
Positive factor - > (iatrogenic risk reduction)	in the afferent jejunal loop
(8) CBD stones, SOD, acute pancreatitis in children/CBD	A, B, C, D, E +	a, b, c, d, e, f +
stones in patients with normal or thin CBD	(G) difficult laparoscopic CBD exploration and risk	(h) avoidance of
Positive factor -> (iatrogenic risk reduction)	of stenosis of the suture	sphincterotomy in children
(9) CBD stones and/or SOD after failure of preoperative	A, B, C, D, E	a, b, c, d, e, f
ERCP-ES or recurrence of acute biliary pancreatitis
Positive factor - > (iatrogenic risk reduction)
(10) Inexperienced surgeon for laparoscopic CBD exploration	A, B, C, D, E, G	a, b, c, d, e, f
Positive factor - > (iatrogenic risk reduction)

Citation: La Greca G, Barbagallo F, Di Blasi M, Chisari A, Lombardo R, Bonaccorso R, Latteri S, Di Stefano A, Russello D. Laparo-endoscopic “Rendezvous” to treat cholecysto-choledocolithiasis: Effective, safe and simplifies the endoscopist’s work. World J Gastroenterol 2008 May 14; 14(18): 2844-2850. Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc[131]”. CBD: Common bile duct; ERCP: Endoscopic retrograde cholangio-pancreatography; ES: Endoscopic sphincterotomy; IOC: Intraoperative cholangiography; SOD: Sphincter of Oddi dysfunction.