ERCP+LC Vs. LC+LCBDE Management For Cholecystolithiasis And Choledocholit-hiasis: A Prospective Clinical Study

Backgroud About 3% to 10% of patients have cholecystolithiasis accompanied by common bile duct stones. Although laparoscopic cholecystectomy is the main method for gallbladder stones, there are still different kinds of views about the optimal treatment of gallstones accompanied by common bile duct stones. Nowadays, the main argument is how to choose the managements between one step surgery(laparoscopic cholecystectomy and common bile duct exploration, LC + LCBDE) and two steps surgery(endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy, ERCP + LC). Although Both of them could achieve a good result, they also have some different characteristics, including advantages and disadvantages. Which is better,that is a question.Aim This study is a prospective randomized clinical research. The aim of this study is to find out which kinds of treatment is better in the patients with gallstones accompanied by common bile duct stones.Methods Between Jul 2014 and Jan 2016, there were 60 patients who had cholecystolithiasis accompanied with common bile duct stones enrolled in the department of minimally invasive surgery, Tianjin Nankai Hospital.Sixty patients were divided into the one step group and two step group by random number table. We compared the efficiency of stone clearance, the bleeding volume, the operation time, the hospitalization time, the anal aerofluxus time, the postoperative pain, the postoperative satisfaction, the cost of hospitalization, and bleeding, pancreatitis, perforation, recurrence of common bile duct stones, acute cholangitis,et al short-term and long-term complications between two groups.Results There were Sixty patients who had cholecystolithiasis accompanied by common bile duct stones enrolled in this trial, thirty patients in the LC+LCBDE group and 30 in ERCP+LC group. There was no significant difference in their basic lines such as gender, age, clinical symptoms, liver function, bile duct diameter, the largest diameter of common bile duct stones, and the number of stones(P > 0.05).During the laparoscopic surgery, there were no significant differences in abdominal adhesion, conversion to open surgery and surgical success rate(P >0.05). However, the intraoperative bleeding volume, the operation time, postoperative abdominal drainage cases in ERCP+LC group were less than the LC+LCBDE group(P < 0.05). There was significant difference between two groups in abdominal pain(P < 0.05).But the abdominal distension, fever and the symptoms of digestive system such as nausea and vomiting were also similar between two groups(P > 0.05). Both the off-bed ambulation time and the anal aerofluxus time were earlier in ERCP+LC group than that in LC+LCBDE group(P < 0.05).The ERCP+LC group was better than the LC+LCBDE group in postoperative pain and postoperative satisfaction(P < 0.05).And the stone clean rate and average hospitalization time were similar in two groups(96.67% vs 100%?9.5±3.2vs8.4±3.0, P > 0.05).But the LC+LCBDE group was less than the ERCP+LC group in the cost of hospitalization( P < 0.05).Five patients, who had ERCP+LC,suffered postoperative complications.Three patients who had postoperative complications after endoscopic retrograde cholangiopancreatography were bleeding and acute cholecystitis. The number of patients who had the postoperative complications after laparoscopic cholecystectomy were 2, include wound infection and abdominal infection. Three patients of LC+LCBDE group had postoperative complications, such as acute pancreatitis, wound infection and abdominal infection. Longer-term follow-up was conducted 2~21months after the operation and the average time was 16.5±5.3 months. A patient whose common bile duct was out of shape in one step surgery.Conclusions One step and two steps shows a successfully treatment of cholecystolithiasis accompanied by common bile duct stones. Each of them have their own characteristics. The intraoperative bleeding volume, the operation time, postoperative abdominal drainage, the off-bed ambulation time and the anal aerofluxus time are better in ERCP+LC group than that in the LC+LCBDE group. Although the complication is similar, ERCP+LC is more popular because of the minor surgical trauma, quicker recovery and higher satisfaction from patient. However, the LC+LCBDE group have a good advantage in the cost of hospitalization. It is a good choice for the poor patients.