Clinical study on single-stage management for concomitant gallbladder stones and common bile duct stones: ERCP or laparoscopic exploration of common bile duct

Abstract

Objective To compare two approaches of single-stage of treating concomitant gallbladder stones and common bile duct stones. Laparoscopic cholecystectomy (LC) was performed with endoscopic retrograde cholangiography (ERCP) as ERCP group and LC combined with laparoscopic common bile duct exploration (LCBDE) as LCBDE group. Intraoperative ERCP was compared with LCBDE. Methods Retrospective analysis was performed for 189 patients with concomitant gallbladder stones and common bile duct stones in our hospital from January 2017 to December 2018. A total of 111 cases were in ERCP group using LC with ERCP and 78 cases in LCBDE group using LC with LCBDE. The efficacy, safety and economy of two approaches were investigated. Results No statistical significance was present between two groups in gender, age, BMI, ASA grade, and preoperative examination (P>0.05). Significant difference was not found in stone clearance rate and postoperative complications(P>0.05). The cases in LCBDE group had wider indication with more patients of gastric surgery history and larger stones. The cases in ERCP group had less hospital days (6.79±2.78 d vs. 13.18±5.43 d, P<0.01), faster postoperative recovery, but higher total cost of hospitalization (35 746.86±7 048.23 Yuan vs. 30 422.74±8 698.72 Yuan, P<0.01). Conclusions Both LC combined with ERCP and with LCBDE are safe and effective to treat gallbladder stones and common bile duct stones. LC with ERCP can treat most cases with faster postoperative recovery, although the cost is higher. LC with LCBDE has the advantages in cases with gastric surgery history and larger stones.

Keywords

• |common bile duct stones|laparoscopy|endoscopic retrograde cholangiography（ercp）|common bile duct exploration