Comparison of Laparoscopic Common Bile Duct Exploration Combine with Cholecystectomy and Laparoscopic Cholecystectomy with Preoperative Endoscopic Sphincterotomy: In Terms of Surgical Outcomes and Recurrences

Abstract

Introduction: It is controversial whether Laparoscopic common bile duct exploration (LCBDE) combine with laparoscopic cholecystectomy(LC) is better than LC with preoperative endoscopic sphincterotomy (pre-EST) for management of choledocholithiasis. Methods: 157 patients who underwent LCBDE+LC and 278 patients who underwent pre-EST+LC from January 2010 to December 2018 in single institution were retrospectively reviewed the preoperative characteristics, surgical outcomes, and recurrence of choledocholithiasis. Results: The maximum CBD diameter (13.2 vs 9.5mm, p< 0.001) and the maximum stone size (11.4 vs 6.3mm, p< 0.001) was significantly larger in patients who underwent LCBDE+LC than pre-EST+LC. Multiple stones were also frequently found in LCBDE group (54.8 vs 43.0%, p=0.017). The operative time (111.4 vs 55.6 minutes, p< 0.001) was significantly longer in LCBDE group, while duration of hospital stays after first procedure (6.2 vs 9.8days, p< 0.001) was significantly shorter in LCBDE group. There is no statistical significance in conversion to open surgery (1.9 vs 0.4%, p=0.104), retained stones rate (3.2 vs 1.4%, p=0.219), and recurrence rate of choledocholithiasis (8.3 vs 9.4%, p=0.707) between the two groups. In multivariate analysis, old age (over 70years) and CBD dilatation (over 8mm) were risk factor for recurrence of choledocholithiasis. Conclusion: In our experience, LCBDE+LC can be a safe and feasible management for choledocholithiasis, if appropriate experience and when expertise is available. High risk group of recurrence of CBD stone with old age and dilated CBD should carefully follow-up.