Efficacy And Safety Of LERV In The Treatment Of Fine Diameter Choledocholithiasis

Objective: Choledocholithiasis is a common clinical disease,secondary to gallstone mostly.Once choledocholithiasis is diagnosed,surgery is recommended if tolerated.At present,there are many related surgical treatment options,but the best way is still up in the air.For patients with fine diameter common bile duct(the maximum inner diameter of the middle part of common bile duct ≤10mm),most hospital at home and abroad use Pre ERCP+LC for treatment,but the best method has certain limitations,including a high incidence of post-ERCP pancreatitis(PEP)and the need for secondary surgery.However,the laparoscopic-endoscopic rendezvous(LERV)has gradually attracted the attention of researchers in recent years.Some foreign studies reported that it is superior to secondary surgery in terms of efficacy,safety and economic index.But domestic reports are still lacking.Our study retrospectively analyzed and evaluated the efficacy and safety of LERV,so as to provide reference for the surgical treatment of clinical choledocholithiasis.Methods : There was a retrospective cohort.The study included patients with choledocholithiasis who underwent LERV or ERCP plus secondary LC surgery in our hospital during a total of 4 years from October 2018 to September 2022,and the patients were divided into LERV group and Pre ERCP+LC group according to different surgical methods.Basic data(age,gender,BMI),clinical manifestations(symptoms,signs,past history),preoperative and postoperative related laboratory indicators(WBC,TBIL,ALT,GGT,AMY,LPS),images of the common bile duct and stones(size and number of stones,internal diameter of choledocholithiasis),the information of ERCP and cholecystectomy(success rate of stone extraction,ERCP operation duration and intraoperative blood loss)and postoperative conditions(complications,indwelling time of ENBD tube,length of hospital stay,hospitalization and surgical costs)were analyzed by statistical methods such as T-test,chi-square test or rank sum test,and the differences in efficacy,safety and economic index between the two groups were compared.Results: ⑴ A total of 79 patients with choledocholithiasis were collected,including 38 patients in LERV group and 41 patients in Pre ERCP+LC group.There were no significant differences in the basic data,clinical manifestations,preoperative related laboratory indexes,images of the common bile duct and stones between the two groups(P > 0.05).⑵ In terms of efficacy,the success rate of stone removal in LERV group was97.37%(37/38)and Pre ERCP +LC success rate was 92.68%(38/41),and there was no significant difference(P > 0.05).In terms of the success rate of intubation,there was no case of failed intubation in LERV and 1 case of failed intubation in Pre ERCP+LC group,with a success rate of 97.56%.There was no statistically significant difference between the two groups(P > 0.05).⑶ In terms of safety,there were no significant differences in operation duration(122.5 min vs.125 min,P > 0.05)and intraoperative blood loss(15 ml vs.10 ml,P >0.05)between the two groups,and no serious complications occurred.However,TBIL(14.5 umol/L vs.20.4 umol/L,P < 0.05),LPS(57 U/L vs.227 U/L,P < 0.001)and GGT(97 U/L vs.190.5 U/L,P < 0.01)were significantly lower than those in Pre ERCP+LC group.The total complication rate(13.2% vs.34.1%,P < 0.05)and amylase increase rate(10.5% vs.31.7%,P < 0.05)were significantly lower than those of the latter,and PEP and other related complications(liver function impairment,bleeding,abdominal infection,etc.)were significantly lower than those of the latter.There was no significant difference between the two groups(P > 0.05).⑷ In terms of economic indicators,the average length of hospital stay in LERV group was significantly shorter than that in Pre ERCP+LC group(9.5 days vs.15 days,P < 0.001),with statistical difference.There was no significant difference between the two groups in total hospitalization expenses(40061.68 yuan vs.44227.89 yuan)and surgery-related expenses(10519.50 yuan vs.10625.00 yuan,P > 0.05).Conclusion: Both surgical methods are effective and safe for the treatment of secondary fine diameter choledocholithiasis,but compared with the current conventional treatment Pre ERCP+LC,LERV surgery has less impact on the body and can significantly shorten the average length of hospital stay and improve patients’ medical experience.