Comparative Analysis Of The Efficacy Of ERCP And LCBDE In The Treatment Of Recurrent Common Bile Duct Stones

Objective To compare the effects of endoscopic retrograde cholangiopancreatography(ERCP)and laparoscopic common bile duct exploration(LCBDE)for recurrent common bile duct stones(CBDS)on patients’ postoperative clinical indicators and complications,so as to evaluate the efficacy of the two procedures for recurrent CBDS.Methods The clinical records of 134 patients with treated recurrent CBDS from January 2018to June 2022 were retrospectively collected from the Department of General Surgery of Gansu Provincial People’s Hospital and grouped into ERCP and LCBDE groups according to treatment modality to compare the baseline information of admission,first stone extraction success rate,intraoperative bleeding,operative time,total hospital stay,total hospital cost,between the two groups and preoperative and postoperative laboratory indices,such as total bilirubin(TBIL),direct bilirubin(DBIL),alanine aminotransferase(ALT),aspartate aminotransferase(AST),gamma-glutamyl transferase(GGT),alkaline phosphatase(ALP),and the incidence of postoperative complications between the two groups and between the same groups.Results A total of 134 patients meeting the inclusion criteria were collected,including 70 patients in the ERCP group,including 36 males and 34 females,aged 55.04±12.09 years,and64 patients in the LCBDE group,including 26 males and 38 females,aged 53.39±11.55 years,with no statistical difference in the baseline information between the two groups(P>0.05).There was no statistical difference in the first stone extraction success rate between the two groups(P>0.05),but there was a statistical difference in intraoperative bleeding,operative time,total hospital stay,and total hospital cost(P<0.05).Intraoperative bleeding was12.99±2.12 ml in the ERCP group and 47.45±12.30 ml in the LCBDE group;operative time was 30.21±4.81 min in the ERCP group and 108.47±8.50 min in the LCBDE group;Total hospital stay was 7.87±2.25 days in the ERCP group and 11.59±2.48 days in the LCBDE group;Total hospital cost was 18582.68±3031.66 yuan in the ERCP group and26966.40±5468.89 yuan in the LCBDE group.In terms of intraoperative bleeding,operative time,total hospital stay,and total hospital cost,the ERCP group was lower than the LCBDE group(P<0.05).However,there was no statistical difference in the preoperative and postoperative laboratory indices between the ERCP and LCBDE groups(P>0.05),but there was a statistical difference in preoperative and postoperative laboratory indices between the two groups within their respective groups,and the postoperative laboratory indexes(TBIL,DBIL,ALT,AST,GGT,ALP)were lower than preoperative ones(P<0.05).Among the postoperative complications in the ERCP and LCBDE groups,there was a statistical difference in the incidence of pancreatitis,the incidence of pancreatitis was lower in the LCBDE group than in the ERCP group(P<0.05),while there was no statistical difference in the incidence of other complications(P>0.05).Conclusion In the treatment of recurrent CBDS,both ERCP and LCBDE have achieved more satisfactory results.In comparison,ERCP has a shorter operative time,less intraoperative bleeding,and lower total hospital stay and total hospital costs than LCBDE,while the incidence of postoperative pancreatitis is lower in LCBDE than in ERCP.Regarding the occurrence of other early postoperative complications and distant complications,there is no significant difference between the two groups.The specific choice of treatment depends on the patient’s physical condition,disease and other specific circumstances.