Clinical Application of ERCP Concurrent Laparoscopic Cholecystectomy in the Treatment of Cholecystolithiasis Complicated with Extrahepatic Bile Duct Stones

Abstract

ObjectiveTo compare the clinical efficacy of endoscopic retrograde cholangiopancreatography (ERCP) combined with laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration and lithotomy (LCBDE) in the treatment of cholecystolithiasis combined with bile duct stones. MethodsFrom September 2018 to January 2022, 195 patients with cholecystolithiasis complicated with extrahepatic bile duct stones from Department of Department of General Surgery, Shanghai Jiading Central Hospital met the inclusion criteria, including 60 cases in the LC group and 86 cases in the LCBDE group. The general condition, operation success rate, complications and residual stone rate of the two groups were retrospectively analyzed. ResultsIn the simultaneous operation group, 58 patients successfully performed ERCP, and the indwelling rate of the abdominal drainage tube (41.7% vs. 95.3%) was significantly better than that in the LCBDE group. There was no significant difference in the conversion rate to open surgery, operation time, and intraoperative blood loss between the two groups. In the simultaneous surgery group, 4 patients (6.7%) developed pancreatitis after ERCP, which was cured by conservative treatment. The pain score at 6 hours after operation was significantly lower than that in the LCBDE group (3.9±1.6 vs 6.5±2.4). There were no significant differences in biliary leakage (1.7% vs. 4.7%), postoperative cholangitis (5.0% vs. 5.8%), incision infection (3.3% vs. 3.5%), and bile duct stone residue rate (5.0% vs 3.5%) between the two groups. There was no severe pancreatitis, second operation or death. The duration of hospital stay was shortened in the concurrent operation group (5.1±2.3d vs 7.9±3.7d), and the operation cost was significantly higher than that in the LCBDE group (48839.9±8549.5 vs 34635.9±5893.7 yuan). ConclusionERCP combined with LC and LCBDE are both safe and effective methods for the treatment of cholecystolithiasis combined with extrahepatic bile duct stones. The simultaneous operation group has certain advantages in patient comfort and rapid rehabilitation, which can be popularized in qualified units.