Study designs of evaluations included in the review
Randomised controlled trials (RCTs) were eligible for inclusion in the review.
Specific interventions included in the review
Studies in which endoscopy (endoscopic retrograde cholangiopancreatography, ERCP) plus surgery was compared with surgery alone were eligible for inclusion. The included studies compared endoscopy plus surgery with either open or laparoscopic surgery.
Participants included in the review
Although no inclusion criteria for the participants were explicitly stated, it was clear that patients undergoing common bile duct surgery were eligible for inclusion. All of the participants had choledocholithiasis in association with cholecystolithiasis. The authors reported no details of the participants in the included studies, other than that two trials excluded patients from undergoing laparoscopic exploratory surgery if the duct was less than 6 mm in diameter.
Outcomes assessed in the review
No outcome inclusion criteria were stated. The included studies reported on the following outcomes: successful duct clearance, total morbidity, mortality, major morbidity and additional procedures after initial intervention. In the review, conversion from laparoscopy to open surgery was considered a morbidity event. Major complications were defined as intra-abdominal sepsis, cholangitis, clinical pancreatitis, pneumonia, major bleeding requiring transfusion or intervention, myocardial infarction, stroke and early unplanned reoperation. Minor complications were defined as biochemical pancreatitis, minor bile leak, atelectasis, wound infection and urinary tract infection.
How were decisions on the relevance of primary studies made?
The authors did not state how the papers were selected for the review, or how many authors performed the selection.