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

Abstract

Abstract:

ObjectiveTo 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.MethodsRetrospective 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.ResultsNo 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 dvs.13.18±5.43 d,P<0.01), faster postoperative recovery, but higher total cost of hospitalization (35 746.86±7 048.23 Yuanvs.30 422.74±8 698.72 Yuan,P<0.01).ConclusionsBoth 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.

Key words:Common bile duct stones,Laparoscopy,Endoscopic retrograde cholangiography（ERCP）,Common bile duct exploration

CLC Number:

R657.42

WANG Shenjie, MAO Zhihai, ZHENG Minhua. Clinical study on single-stage management for concomitant gallbladder stones and common bile duct stones: ERCP or laparoscopic exploration of common bile duct[J]. Journal of Surgery Concepts & Practice, 2020, 25(01): 65-68.

Figures/Tables3

项目	ERCP组（n=111）	LCBDE组（n=78）	P值
性别			0.080
男	54	48
女	57	30
年龄（岁）	56.41±15.16	55.64±16.50	0.753
BMI			0.131
≥24	40	20
<24	71	58
ASA分级			0.518
1~2	72	47
3~4	39	31
肝功能异常			0.318
有	72	45
无	39	33
血常规异常			0.457
有	7	3
无	104	75
既往胃部手术史	0	5	<0.01

项目	ERCP组（n=111）	LCBDE组（n=78）	P值
结石数			0.223
单发	57	47
多发	54	31
结石直径（mm）	5.32±1.89	8.65±3.07	<0.01
胆总管直径（mm）	9.60±2.86	10.55±2.39	<0.01
结石取净率	97.3%（108/111）	94.8%（74/78）	0.625
并发症发生率	5.4%（6/111）	3.8%（3/78）	0.362

项目	ERCP组（n=111）	LCBDE组（n=78）	P值
住院时间（d）	6.79±2.78（3~19）	13.18±5.43（4~30）	<0.01
住院总费用（人民币：元）	35 746.86±7 048.23	30 422.74±8 698.72	<0.01

References12

[1]	Sarli L, Pietra N, Franzé A, et al. Routine intravenous cholangiography, selective ERCP, and endoscopic treatment of bile duct stones before laparoscopic cholecystectomy[J]. Gastrointest Endosc, 1999, 50(2):200-208. pmid:10425413
[2]	Lella F, Bagnolo F, Rebuffat C, et al. Use of the laparoscopic-endoscopic approach, the so-called “rendezvous” technique, in cholecystocholedocholithiasis: a valid method in cases with patient-related risk factors for post-ERCP pancreatitis[J]. Surg Endosc, 2006, 20(3):419-423. pmid:16424987
[3]	Chang L, Lo S, Stabile BE, et al. Preoperative versus postoperative endoscopic retrograde cholangiopancreato-graphy in mild to moderate gallstone pancreatitis: a prospective randomized trial[J]. Ann Surg, 2000, 231(1):82-87. pmid:10636106
[4]	Hong DF, Xin Y, Chen DW. Comparison of laparoscopic cholecystectomy combined with intraoperative endoscopic sphincterotomy and laparoscopic exploration of the common bile duct for cholecystocholedocholithiasis[J]. Surg Endosc, 2006, 20(3):424-427. pmid:16395539
[5]	Cuschieri A, Lezoche E, Morino M, et al. E.A.E.S. multicenter prospective randomized trial comparing two-stagevs. single-stage management of patients with gallstone disease and ductal calculi[J]. Surg Endosc, 1999, 13(10):952-957. pmid:10526025
[6]	Rhodes M, Sussman L, Cohen L, et al. Randomised trial of laparoscopic exploration of common bile duct versus postoperative endoscopic retrograde cholangiography for common bile duct stones[J]. Lancet, 1998, 351(9097):159-161. pmid:9449869
[7]	Bansal VK, Misra MC, Rajan K, et al. Single-stage laparoscopic common bile duct exploration and cholecystectomy versus two-stage endoscopic stone extraction followed by laparoscopic cholecystectomy for patients with concomitant gallbladder stones and common bile duct stones: a randomized controlled trial[J]. Surg Endosc, 2014, 28(3):875-885.
[8]	Qian Y, Xie J, Jiang P, et al. Laparoendoscopic rendezvous versus ERCP followed by laparoscopic cholecystectomy for the management of cholecysto-choledocholithiasis: a retrospectively cohort study[J]. Surg Endosc, 2019-08-19.[Epub ahead of print]
[9]	La Barba G, Gardini A, Cavargini E, et al. Laparoendoscopic rendezvous in the treatment of cholecysto-choledocholitiasis: a single series of 200 patients[J]. Surg Endosc, 2018, 32(9):3868-3873.
[10]	Ghazal AH, Sorour MA, El-Riwini M, et al. Single-step treatment of gall bladder and bile duct stones: a combined endoscopic-laparoscopic technique[J]. Int J Surg, 2009, 7(4):338-346. doi:10.1016/j.ijsu.2009.05.005pmid:19481184
[11]	Tsiopoulos F, Kapsoritakis A, Psychos A, et al. Laparoendoscopic rendezvous may be an effective alternative to a failed preoperative endoscopic retrograde cholangiopancreatography in patients with cholecystocholedocholithiasis[J]. Ann Gastroenterol, 2018, 31(1):102-108.
[12]	Ding G, Cai W, Qin M. Single-stagevs. two-stage ma-nagement for concomitant gallstones and common bile duct stones: a prospective randomized trial with long-term follow-up[J]. J Gastrointest Surg, 2014, 18(5):947-951.

[1]	GUO Liangqi, YAN Zhilong, ZHANG Moucheng.Laparoscopic intragastric surgery in treating of gastric submucosal tumor and early gastric cancer[J]. Journal of Surgery Concepts & Practice, 2022, 27(04): 380-383.
[2]	ZHANG Bo, HUANG Xia.Clinical effect and prognosis analysis of laparoscopic cholecystectomy combined with cholangioscopy and duodenoscopy in treatment of gallbladder stones associated with choledocholithiasis[J]. Journal of Surgery Concepts & Practice, 2021, 26(03): 254-258.
[3]	WU Lisheng, YU Jianwei, LI Yu, DAI Congcong.Laparoscopic sleeve gastrectomy with four ports and posterior gastric wall dissection first: a report of 122 cases[J]. Journal of Surgery Concepts & Practice, 2020, 25(05): 422-425.
[4]	LIANG Yun, JIANG Chongyi, ZHAO Liting, WANG Hongwei, HU Pengfei, CAI Zhiwei, WANG Wei.Laparoscopic pancreaticoduodenectomy in elderly patients: a feasibility study[J]. Journal of Surgery Concepts & Practice, 2020, 25(01): 60-64.
[5]	LI Jindong, WANG Chenxing, LI Jianwen, HAO Xiaohui, FENG Bo, YUE Fei, HE Zirui, XUE Pei..Clinical characteristics and laparoscopic strategy of female inguinal hernia with cyst of round ligament of uterus[J]. Journal of Surgery Concepts & Practice, 2020, 25(01): 69-73.
[6]	QIAN Chen, YANG Feng, XU Yingjie, HE Jun, MAO Qibin, YU Judian, ZHENG Zhi.Comparative study on short-term results of radical gastrectomy in gastric cancer patients: 3D versus 2D laparoscopy or open surgery[J]. Journal of Surgery Concepts & Practice, 2019, 24(06): 530-534.
[7]	WANG Hebin, PENG Feng, ZHU Feng, WANG Min, QIN Renyi.Laparoscopic versus open pancreaticoduodenectomy: short-term clinical efficacy evaluation[J]. Journal of Surgery Concepts & Practice, 2019, 24(03): 222-225.
[8]	XU Guoquan, GU Chunfei, YU Linhai, FENG Linsong, CHU Yongyue, ZHU Haifeng, FANG Shengli..Cyst duct drainage in laparoscopic common bile duct exploration with primary closure[J]. Journal of Surgery Concepts & Practice, 2019, 24(03): 249-253.
[9]	JIANG Yimei, LIU Kun, SHI Yiqin, SONG Zijia, LI You, ZHAO Ren.Single-port and three-port laparoscopic radical resection in colorectal cancer： a retrospective study[J]. Journal of Surgery Concepts & Practice, 2018, 23(05): 418-424.
[10]	YUE Fei, HAO Xiaohui, LI Jianwen, WANG Wenrui, SUN Jing, HE Zirui, XUE Pei, Feng Bo, ZHENG Minhua.Experiences of laparoscopic repair for suprapubic hernia[J]. Journal of Surgery Concepts & Practice, 2018, 23(04): 333-336.
[11]	GUAN Ruoyu, YANG Kui, MA Di, YANG Yuchen, CHEN Yongjun.Comparison between robotic liver resection and laparoscopic liver resection[J]. Journal of Surgery Concepts & Practice, 2018, 23(04): 346-351.
[12]	.[J]. Journal of Surgery Concepts & Practice, 2017, 22(06): 504-508.
[13]	.[J]. Journal of Surgery Concepts & Practice, 2017, 22(06): 489-492.
[14]	.[J]. Journal of Surgery Concepts & Practice, 2017, 22(06): 499-503.
[15]	.[J]. Journal of Surgery Concepts & Practice, 2017, 22(04): 343-346.