Single-Stage Rendezvous Procedures in Patients with Gallstone Disease Complicated by Choledocholithiasis: Results of a Comparative Cohort Study

Background. The prevalence of choledocholithiasis among patients with gallstone disease reaches 30%. The most common approach in the treatment of these patients is a two-stage surgical strategy: endoscopic transpapillary interventions followed by laparoscopic cholecystectomy. A single-stage approach, the rendezvous technique, is being actively introduced, performing these interventions in a single operation under one anesthesia. However, due to conflicting results from existing comparative studies, there is currently no unified consensus on the choice of optimal surgical tactics, which necessitates further study of this topic. Objective – to evaluate the safety of single-stage rendezvous surgical interventions in patients with acute and chronic calculous cholecystitis complicated by choledocholithiasis. Patients and methods. A retrospective comparative cohort study of 71 patients was performed, of whom 56 (78.9%) had obstructive jaundice of varying severity. The observation group consisted of 30 (42.3%) patients who underwent rendezvous surgery. The control group included 41 (57.7%) patients who were treated with a two-stage approach. The samples in both groups were representative. The frequency of transient hyperamylasemia (HAE) episodes in the postoperative period, specific postoperative complications (Post-ERCP Acute Pancreatitis, cholangitis, biliary peritonitis, papillar bleeding), as well as the duration of surgery and hospitalization time were assessed. Results. In the observation group, episodes of transient HAE without progression to Post-ERCP Acute Pancreatitis were noted in 6 (20.0%) patients, compared to 9 (22.0%) in the control group (p = 1.00). The total number of specific postoperative complications occurred in 4 (13.3%) patients in rendezvous group and 3 (7.3%) in the comparison group (p = 0.44). Post-ERCP Acute Pancreatitis developed in 3 (10.0%) and 2 (4.9%) patients, respectively (p = 0.64). In the observation group, 1 (3.3%) case of papillar bleeding was recorded, while in the control group, there was 1 (2.4%) case of biliary peritonitis. The average hospitalization duration was significantly shorter in the observation group (11.5 (9.0–14.7) vs. 15.0 (12.0–17.0), p = 0.01). There were no cases of postoperative cholangitis. No deaths occurred. Conclusion. Performing single-stage rendezvous surgical interventions in patients with acute and chronic calculous cholecystitis complicated by choledocholithiasis and obstructive jaundice is a safe treatment method, comparable to the traditional two-stage approach.