Comparison Of Laparoscopic Common Bile Duct Exploration And Endoscopic Sphincterotomy For Common Bile Duct Stones After Cholecystectomy

Objective:To compare and analyze the curative effect for common bile duct stones after cholecystectomy by laparoscopic common bile duct exploration(LCBDE)and endoscopic sphincterotomy(EST).Methods:Retrospective analysis of the clinical data of 35 patients who underwent LCBDE for choledocholithiasis after cholecystectomy between January 2017 to August 2018 in our hospital,an age-matched 56 similar patients treated with EST at the same period as a control.The postoperative complication rate,residual stone rate,postoperative hospital stay and hospitalization expenses were compared between the two groups.Results:There were no significant differences in gender,age,common bile duct diameter,and chronic disease condition between the two groups(P>0.05).2 patients(5.7%)had found cholangitis after operation in the LCBDE group,and there were no complications such as bile leakage,hemorrhage,peritonitis and wound infection;There was 13 patients with postoperative complications in the EST group,including 5 cases of acute pancreatitis(8.9%),1 case of gastrointestinal bleeding(1.8%),2cases of postoperative reactive pleural effusion(3.6%),5 cases of postoperative cholangitis(8.9%),the total Complication rate is 23.2%,all cases cured by conservative treatment.There was a statistically significant difference in the postoperative complications rate between the two groups(P<0.05).The average hospitalization cost and average postoperative hospital stay in the LCBDE group and the EST group were26448.97±8617.103,24355.79±11170.596,and 4.80±1.91 and 4.29±4.48,respectively,and the difference was statistically significant(P<0.05).One case(2.9%)of stone failure found in LCBDE group,no stone residual is found.1 case failed in stone removal by LCBDE,and there was no residual stone after operation.In the EST group,4 cases failed in stone removal,three cases of residual stones were found by ERCP one month after operation.No perioperative death occurred in either group.Conclusion:LCBDE combined with one-stage suture of common bile duct for the treatment of common bile duct stones after cholecystectomy is safe and feasible.Compared with EST,LCBDE related to longer hospital stays and higher treatment costs but lower postoperative complication rate and stone residual rate.Simply pursuing hospital stays and hospitalization costs may expose patients to higher risk of postoperative complications.All factors should be considered to provide the best treatment for patients.