Clinical Effect Of Primary Suture After Two-endoscopies Exploration In The Treatment Of Elderly Patients With Cholecystolithiasis And Choledocholithiasis

Objective To investigate the efficacy of laparoscopic choledochoscopic exploration(LCBDE)+laparoscopic cholecystectomy(LC)followed by primary suture in the treatment of elderly patients with cholecystolithiasis and choledocholithiasis.Methods Data of 78 elderly patients with cholecystolithiasis complicated with choledocholithiasis treated in the Department of Hepatobiliary Surgery of the First Affiliated Hospital of Bengbu Medical College from June 2019 to June 2021 were retrospectively analyzed.All patients were treated with LC+LCBDE and divided into two groups according to the different treatment methods of residual bile duct during operation: 38 cases in the primary suture group,undergoing primary suture directly after bile duct incision and stone extraction;40 cases in the T-tube drainage group,with bile duct incision after stone indwelling T tube.The preoperative basic information,intraoperative conditions,C-reactive protein level and NRS pain score on the first postoperative day,VTE risk score on the third postoperative day,hospitalization,postoperative complications,stone residual status were compared between the two groups.Results All patients underwent LC+LCBDE surgery,and the primary suture group was superior to the T-tube drainage group in terms of operation time,first feeding time,the level of C-reactive protein on the first postoperative day,NRS pain score on the first postoperative day,abdominal drainage tube removal time,first time out of bed time,postoperative hospital stay and hospitalization cost(all P<0.05).There were no significant differences in intraoperative blood loss,VTE risk score on the third day after surgery,postoperative complications,stone residue between the two groups.Conclusions By grasping the indications,LC+LCBDE+common bile duct primary suture has certain advantages over T-tube drainage for elderly patients with cholecystolithiasis and choledocholithiasis.The patients recover faster,have less pain.Primary suture after two-endoscopies exploration is safe and effective,and is in line with the concept of accelerated rehabilitation surgery,which is worthy of clinical application.