Rigid nephroscopy vs flexible cholangioscopy in laparoscopic common bile duct exploration for patients with choledocholithiasis

Abstract

Objective To explore the clinical value of rigid nephroscopy and flexible cholangioscopy in laparoscopic common bile duct exploration in the treatment of choledocholithiasis. Methods A retrospective analysis of forty seven cases of choledocholithiasis undergoing laparoscopic common bile duct exploration in our hospital from January 2014 to January 2016 was carried out. All the cases were diagnosed with choledocholithiasis by CT and ultrasonography before operations. According to the different endoscopic surgeries, they were divided into flexible cholangioscopy group (23 cases, directly inserting the flexible cholangioscopy into common bile duct) and rigid nephroscopy group (24 cases, firstly inserting the external sheath sized 18-20 into common bile duct, and then putting the rigid nephroscopy from the external sheath). The operation time, operative bleeding, postoperative bleeding, bile leakage, and rates of residual stones was compared between the two groups. Results The difference of operation time between two groups was of statistical significance [(124.2±20.4) min vs (152.8±29.0) min, t=3.924, P<0.05]. The differences of surgical completion rate (100.0% vs 87.0%, χ2=3.344, P=0.067), operative bleeding [(28.70±8.69) ml vs (26.67±8.17) ml, t=0.825, P=0.414)], rate of postoperative bleeding (4.2% vs 0, χ2=0.979, P=0.322), bile leakage (8.3% vs 13.0%, χ2=0.274, P=0.601), and rate of residual stones (0 vs 8.7%, χ2=2.180, P=0.140) between two groups was of no statistical significance. Conclusion For patients with simple choledocholithiasis, it can reduce the operation time using rigid nephroscopy and sheath, and has obvious advantages compared with flexible cholangioscopy in the laparoscopic common bile duct exploration. Key words: Choledocholithiasis; Laparoscopes; Choledochostomy; Neophrostomy, percutaneous