Comparing Two Minimally Invasive Managements Of The Cholecystocholedocholithiasis: A Retrospective Analysis

ObjectiveCurrently, there are two widely implemented managements according to theconcomitant gallstones and common bile duct stones. One is preoperative endoscopicsphincterotomy (EST) combined with subsequent laparoscopic cholecystectomy (LC),that is pre-EST plus LC, the other is laparoscopic cholecystectomy and common bile ductexploration (LC-LCBDE). Through comparison of the two minimally invasivemanagements, including clinical effectiveness, postoperative morbidity, and so forth, wetried to figure out the much more rational, safe, and effective management of thecholecystocholedocholithiasis.MethodsA recent five-year (2007-2012) retrospective analysis has been achieved, in which229patients with concomitant gallstones and common bile duct stones has been included.All the229patients were conformed to our inclusion criteria. Of all the229patients,there are121who received pre-EST combined plus LC, that is group A and also thecontrolled group;108patients who received LC-LCBDE, that is group B. Comparisonwas done between the two groups, including success rate (overall success rate andprimary success rate), conversion rate, primary stone clearance rate, length of hospitalstay, postoperative morbidity and procedures per patient. Statistical analysis was done bySPSS13.0.ResultsOverall success rate of group A was96.7%(117/121), conversion rate was 3.3%(4/121); in group A, of all the117patients who received successfully operatedprocedures,8were performed another one or two preoperative or postoperative EST forretained duct stones, one patient was shifted to an open surgery for unreasonable bile leak,so primary success rate of group A was89.3%(108/121), primary stone clearance rate was90.1%(109/121), postoperative morbidity was9.1%(11/121), average length of hospitalstay was9.8d, procedures per patient were2.1. In group B, overall success rate was98.1%,conversion rate was1.9%, of all the106patients who received successfully operatedprocedures,4patients suffered additional choledoscopy through T-tube for another2-3times due to retained duct srtones, two were shifted to open surgery, so primay success rateof group B was92.6%(100/108), primary stone clearance rate was94.4%(102/108),postoperative morbidity was6.5%(7/108), average length of hospital stay was6.1d,procedures per patient were1.1. Trough our statistical process, though，there was nosignificant gap between A and B in overall success rate, primary success rate, conversionrate, primary stone clearance rate and postoperative morbidity, there are significantdifferences in postoperative higher blood amylase and length of hospital stay, and eachpatient in group B received an obviously less procedures.ConclusionBoth LC-LCBDE and pre-EST plus LC are effective minimally invasivemanagements, however, patient undergone LC-LCBDE may well be equivalently treatedwith obvious less procedures, shorter length of hospital stay and lower incidence ofpostoperative higher blood amylase. In the foreseeable future, LC-LCBDE may probablybe the standard procedure for the concomitant gallstones and common bile duct stones.