Clinical Efficacy Study Of Laparoscopic Versus Open Surgery On Recurrent Choledocholithiasis

Objective To investigate the safety,feasibility and advantages of laparoscopic common bile duct exploration in the treatment of recurrent common bile duct stones.Methods Clinical data of 62 patients with recurrent choledocholithiasis treated in our hospital from January 2016 to December 2020 who had a history of open biliary operation were collected.According to different treatment methods,they were divided into the laparoscopic group(n = 33)and the open group(n = 29).The general basic information,perioperative laboratory indexes,operative time,intraoperative blood loss,intraoperative injury,abdominal drainage flow,T-tube drainage flow,gastrointestinal function recovery,postoperative pain,wound healing,incidence of biliary leakage,abdominal fluid rate,stone residual rate,length of stay and hospitalization expenses of the two groups were compared.Results Four of the 33 patients completed laparoscopic surgery were converted to open surgery,and the conversion rate was 11%(4/37).There were no significant differences between the two groups in general basic information,perioperative laboratory indexes,operative time,intraoperative injury,T-tube drainage volume,incidence of bile leakage,peritoneal effusion rate,and stone residual rate(P > 0.05).The intraoperative bleeding in the laparoscopic group was significantly less than that in the open group(20.35± 14.85 ml vs 57.17± 25.26 ml P=0.000 < 0.05).The number of postoperative analgesia in laparoscopic group was significantly lower than that in open group(48%(16/33)vs 79%(23/29)P=0.012 <0.05).The recovery time of postoperative feeding in laparoscopic group was significantly earlier than that in open group(2.50±1.14 d vs 3.48±1.38 d,P=0.030 <0.05).The number of people who used laxatives after eating in laparoscopic group was significantly lower than that in open group(33%(10/30)vs 66%(19/29)P=0.007 < 0.05);The time of suture removal in laparoscopic group was significantly earlier than that in open group(7.03±1.79 d vs 11.62±3.52 d,P=0.000 < 0.05).The abdominal drainage volume in laparoscopic group was significantly lower than that in open group(P< 0.05).The time to pull out abdominal drainage tube in laparoscopic group was significantly earlier than that in open group(6.03±1.56 d vs7.67±2.65 d,P=0.013 < 0.05).The incision liquefaction or infection in laparoscopic group was significantly less than that in open group(0 vs 17%(5/29)P=0.043 <0.05).The length of stay and hospitalization cost in laparoscopic group were significantly less than those in open group(P< 0.05).Conclusion Laparoscopic choledochal exploration is safe and feasible in the treatment of patients with recurrent choledocholithiasis,and has more clinical advantages than traditional open surgery.