Effect Of Biliary Duct Calculi Size On Surgical Management Of Gallstone Desease With Biliary Duct Calculi

【Objective】: To evaluate the effectiveness of biliary duct calculi stone sizes in two surgical strategies.【Method】: This study was carried out in Quanzhou Hospital of Fujian Medical University,from 1st February 2015 to 31 st November 2018.Patients with gallstone and biliary duct calculi were evaluated.Patients were divided into 3 groups,i.e.,the diameter of biliary duct calculi < 1.0 cm(group-Ⅰ),the diameter of biliary duct calculi 1.0-1.5cm(group-Ⅱ),and those who had large biliary duct calculi which were >1.5 cm(group-Ⅲ).Data regarding age,sex,diameter of common bile duct,diameter of biliary duct calculi,operation time,length of hospitalization,intraoperation bleeding loss,complications,and outcomes were collected and analysed.【Results】: Total of 262 patients underwent LCBDE+LC(laparoscopic common bile duct exploration+ laparoscopic cholecystectomy)or ERCP+LC(Endoscopic retrograde cholangiopancreatography+ laparoscopic cholecystectomy).Group-Ⅰ comprised 120 patients(85%),Group-Ⅱ comprised 83 patients(15%),and Group-Ⅲ comprised 35 patients.The baseline characteristics of the three groups were similar.In three groups,the success rate of ERCP+LC was97.1%、89.6%、72.7%,LCBDE+LC was 94.1% 、 96.2% 、 91.7%.ERCP+LC was less than LCBDE+LC in terms of intraoperative blood loss.The time of postoperative stay and operation time was significantly shorter in the ERCP+LC than in the LCBDE+LC of group-Ⅰ(4.85 days vs.6 days,74.48 min vs.99.98 min,P<0.05).However,there was not differ significantly between ERCP+LC and LCBDE+LC in groups-Ⅱ,group-Ⅲ(groups-Ⅱ,6.04 days vs.7.68 days,95.48 min vs.104.09 min,P > 0.05;group-Ⅲ,6.2 days vs.7.36 days,100.90 min vs.129 min,P>0.05).Surgical complication rates were similar between ERCP+LC and LCBDE+LC in three groups.【 Conclusion 】 :For group-Ⅰ(the diameter of biliary duct calculi < 1.0 cm),ERCP+LC is technically safe and feasible,with a simpler process that reduces the operation time.For the group-Ⅱ(the diameter of biliary duct calculi 1.0-1.5cm),LCBDE+LC,performed by experienced surgeons,is superior to ERCP+LC because of higher success rate.For group-Ⅲ(the diameter of biliary duct calculi >1.5 cm),LCBDE+LC is more effectively and safely.