Case-control study on necessity of cholecystectomy for patients with bile duct stones combined with gallbladder stones after clearance of stones

Abstract

Objective To discuss necessity of cholecystectomy for patients with stones in their bile ducts and gallbladders in the absence of absolute operation indications of cholecystectomy after clearance of bile duct stones with ERCP. Methods Data of less than 70-year-old patients with stones in their bile ducts and gallbladders but without absolute operation indications of cholecystectomy admitted to the First People′s Hospital of Hangzhou from January 2012 to December 2014 were retrospectively analyzed. Patients were divided into cholecystectomy group and gallbladders in situ group after bile duct stones removal with ERCP. The hospitalization time, recurrent biliary events, complications of operation were compared between two groups. Results A total of 128 patients were included and followed up for (24.031±9.170) months with 64 cases in conservative group and 64 cases in cholecystectomy group. Incidence of recurrent biliary events in the cholecystectomy group and conservative group were 7.8% (5/64) and 10.9%(7/64) (P=0.544). Among cases of recurrent biliary events, incidences of cholangitis in the two groups were 7.8%(5/64) and 4.7%(3/64) respectively (P=0.465), incidences of pancreatitis were 0(0/64) and 1.6%(1/64) respectively (P=0.315), incidences of common bile duct stones were 7.8%(5/64) and 7.8%(5/64) respectively (P=1). No recurrent cholecystitis occurred. There were no differences in ERCP-related complications between the cholecystectomy group[23.4%(15/64)] and the conservative group[12.5%(8/64)](P=0.107). But 4 patients (6.3%) in cholecystectomy group had LC-related complications during the follow-up period, 3 cases of infection and 1 ileus. The hospital stay in conservative group was shorter than that in cholecystectomy group (5.906±4.614 days VS 14.313±6.312 days, P<0.001). The hospitalization expenses in two groups were (45 196±12 518) yuan and (22 160±11 755) yuan(P<0.001). Conclusion Conservative methods yield to shorter hospitalization and lower expenses without cholecystectomy-related complications. Conservative management for gallbladder stones after ERCP for biliary duct stones is recommended for patients who had no absolute operation indications of cholecystectomy. Key words: Common bile duct stones; Gallbladder stones; Retrospective study