Comparison of duodenoscopy followed by laparoscopy and primary suture of common bile duct in treatment of cholecystolithiasis combined with choledocholithiasis / 中华消化内镜杂志

ABSTRACT

Objective:To compare the clinical efficacy of endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) and LC plus laparoscopic common bile duct exploration and primary suture (LBEPS) in treatment of cholecystolithiasis combined with choledocholithiasis.Methods:The clinical data of 161 patients of concomitant cholecystolithiasis and choledocholithiasis treated in Tianjin Nankai Hospital from January 2018 to December 2018 were retrospectively analyzed. Of the patients, 101 cases received ERCP followed by LC (ERCP+ LC group), and 60 cases received LC plus LBEPS (LC+ LBEPS group). The stone clearance rate, complications related to the operation, length of hospital stay, hospitalization expenses, postoperative residual stone rate and postoperative quality of life were compared between the two groups.Results:The ERCP+ LC group and LC+ LBEPS group had no statistical difference in the stone clearance rate [99.01% (100/101) VS 98.31% (59/60), P>0.05] and surgery related complications [5.94% (6/101) VS 6.67% (4/60), P>0.05]. The length of hospital stay of the ERCP+ LC group was significantly longer than that of the LC+ LBEPS group [15.00 (13.00, 19.00) days VS 11.00 (9.50, 13.00) days, P<0.001], and the same of hospitalization cost [57 655.00 (51 237.47, 63 674.32) yuan VS 33 904.18 (28 201.96, 41 785.93) yuan, P<0.001]. The residual stone rate showed significant difference between the ERCP+ LC group and LC+ LBEPS group [16.83% (17/101) VS 0 (0/60), P=0.001]. Both groups were followed up for 3 to 12 months. No long-term complications occurred, and three were no significant differences in the quality of life scores between the two groups ( P>0.05). Conclusion:ERCP followed by LC and LC plus LBEPS are both safe and effective to treatment of cholecystolithiasis combined with choledocholithiasis. The clinicians should select the appropriate method in accordance with the actual condition of the patients.