Table 2.
Main indications for the laparo-endoscopic RV with evaluation of the factors that suggest its preferability instead of the other treatment’s options
| Main indications for the laparo-endoscopic RV | RV preferable vs laparoscopic CBD exploration | RV preferable vs sequential ERCP-ES |
| (1) Common bile duct 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 contrast medium during IOC or T-tube-IOC after laparoscopic CBD exploration | A, B, C, D + (E) high risk of undertreatment of chronic papillitis and of maintenance of underlying causes | a, b, c |
| 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 at the papilla | (d) Avoidance of contrast medium injection with risk of recurrence of cholangitis |
| (5)CBD stones after recurrent acute biliary pancreatitis or hyperbilirubinemia Positive factor -> (iatrogenic risk reduction) | A, B, C, D, E | a, b, c, d +(e) risk of recurrence of ERCP related acute pancreatitis |
| (6) Known or unsuspected Sphincter of Oddi Dysfunction, cholecysto-lithiasis with or without CBD stones | A, B, C, D, E | a, b, c, d, e |
| Positive factor -> (iatrogenic risk reduction) | ||
| (7) CBD stones and/or abovementioned problems in patients with Billroth II during open cholecystectomy Positive factor -> (iatrogenic risk reduction) | A, B, C, D, E + (F) Manual drive of the endoscope by the surgeon in the afferent jejunal loop | a, b, c, d, e + (f) more difficult ERCP |
| (8) CBD stones, SOD, acute pancreatitis in children/CBD stones in patients with normal or thin CBD Positive factor -> (iatrogenic risk reduction) | A, B, C, D, E +(G) difficult laparoscopic CBD exploration and risk of stenosis of the suture | a, b, c, d, e, f +(h) avoidance of sphincterotomy in children |
| (9) CBD stones and/or SOD after failure of preoperative ERCP-ES or recurrence of acute biliary pancreatitis | A, B, C, D, E | a, b, c, d, e, f |
| 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) |