Comparison of surgical efficiency of laparoscopic cholecystectomy and ERCP in treatment of cholecystolithiasis and choledocholithiasis between one stage approach and two stage procedure

doi:10.16139/j.1007-9610.2021.05.015

Abstract

Abstract: Objective To explore the clinical effect of laparoscopic cholecystectomy(LC) combined with endoscopic retrograde cholangiopancreatography (ERCP) in treatment of cholecystolithiasis combined with choledolithiasis in one stage approach compared with two stage procedure. Methods A total of 191 patients with cholecystolithiasis and choledocholithiasis admitted to our hospital from April 2018 to April 2020 were divided into two groups. Ninty-eight patients were treated with LC and ERCP in one stage approach (study group) and 93 patients in two stage procedure(control group). Operative time, bleeding loss, postoperative length of hospital stay, success rate, complication and hospital cost were compared between two groups. Results Compared with two stage procedure in control group, operative time, postoperative length of hospital stay and hospital cost (P<0.05) reduced significantly in one stage approach(study group), and there was no significant difference between two groups in bleeding loss, success rate, and postoperative complications (P>0.05). Conclusions LC with ERCP in one stage approach would be safe and feasible for the patients of cholecystolithiasis and choledolithiasis with advantages of short both operative time and hospital stay and low cost.

Key words: Cholecystolithiasis, Choledocholithiasis, Laparoscopic cholecystectomy, Endoscopic retrograde cholangiopancreatography

CLC Number:

R657.42

HU Gangfeng, HUANG Xia. Comparison of surgical efficiency of laparoscopic cholecystectomy and ERCP in treatment of cholecystolithiasis and choledocholithiasis between one stage approach and two stage procedure[J]. Journal of Surgery Concepts & Practice, 2021, 26(05): 437-440.

Figures/Tables 3

References 19

[1]	Pan L, Chen M, Ji L, et al. The safety and efficacy of laparoscopic common bile duct exploration combined with cholecystectomy for the management of cholecysto-choledocholithiasis: an up-to-date meta-analysis[J]. Ann Surg, 2018, 268(2):247-253. doi: 10.1097/SLA.0000000000002731 URL
[2]	Ricci C, Pagano N, Taffurelli G, et al. Comparison of efficacy and safety of 4 combinations of laparoscopic and intraoperative techniques for management of gallstone disease with biliary duct calculi: a systematic review and network meta-analysis[J]. JAMA Surg, 2018, 153(7):e181167. doi: 10.1001/jamasurg.2018.1167 URL
[3]	Singh AN, Kilambi R. Single-stage laparoscopic common bile duct exploration and cholecystectomy versus two-stage endoscopic stone extraction followed by laparosco-pic cholecystectomy for patients with gallbladder stones with common bile duct stones: systematic review and meta-analysis of randomized trials with trial sequential analysis[J]. Surg Endosc, 2018, 32(9):3763-3776. doi: 10.1007/s00464-018-6170-8 URL
[4]	Williams E, Beckingham I, El Sayed G, et al. Updated guideline on the management of common bile duct stones(CBDS)[J]. Gut, 2017, 66(5):765-782. doi: 10.1136/gutjnl-2016-312317 pmid: 28122906
[5]	Asuri K, Bansal VK, Bagaria V, et al. Long-term outcomes following primary closure of common bile duct following laparoscopic common bile duct(CBD) exploration: experience of 355 cases at a tertiary care center[J]. Surg Laparosc Endosc Percutan Tech, 2020, 30(6):504-507.
[6]	Fang L, Wang J, Dai WC, et al. Laparoscopic transcystic common bile duct exploration: surgical indications and procedure strategies[J]. Surg Endosc, 2018, 32(12):4742-4748. doi: 10.1007/s00464-018-6195-z pmid: 30298446
[7]	Lim J, Wirth J, Wu K, et al. Obesity, adiposity, and risk of symptomatic gallstone disease according to genetic susceptibility[J]. Clin Gastroenterol Hepatol, 2021, S1542-3565(21)00708-4.
[8]	Gilsdorf D, Henrichsen J, Liljestrand K, et al. Laparoscopic common bile duct exploration for choledocholithia-sis: analysis of practice patterns of Intermountain HealthCare[J]. J Am Coll Surg, 2018, 226(6):1160-1165. doi: 10.1016/j.jamcollsurg.2018.02.008 URL
[9]	Navaratne L, Martinez Isla A. Transductal versus transcystic laparoscopic common bile duct exploration: an institutional review of over four hundred cases[J]. Surg Endosc, 2021, 35(1):437-448. doi: 10.1007/s00464-020-07522-7 URL
[10]	Zhu J, Li G, Du P, et al. Laparoscopic common bile duct exploration versus intraoperative endoscopic retrograde cholangiopancreatography in patients with gallbladder and common bile duct stones: a meta-analysis[J]. Surg Endosc, 2021, 35(3):997-1005. doi: 10.1007/s00464-020-08052-y URL
[11]	Zhen W, Xu-Zhen W, Nan-Tao F, et al. Primary closure versus T-tube drainage following laparoscopic common bile duct exploration in patients with previous biliary surgery[J]. Am Surg, 2021, 87(1):50-55. doi: 10.1016/0002-9610(54)90041-0 URL
[12]	ASGE Standards of Practice Committee, Buxbaum JL, Abbas Fehmi SM, et al. ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis[J]. Gastrointest Endosc, 2019, 89(6):1075-1105. doi: S0016-5107(18)33162-6 pmid: 30979521
[13]	Yan Y, Sha Y, Yuan W, et al. One-stage versus two-stage management for acute cholecystitis associated with common bile duct stones: a retrospective cohort study[J]. Surg Endosc, 2021, doi: 10.1007/s00464-021-08349-6. doi: 10.1007/s00464-021-08349-6
[14]	Shah SL, Carr-Locke D. ERCP for acute cholangitis: ti-ming is everything[J]. Gastrointest Endosc, 2020, 91(4):761-762. doi: 10.1016/j.gie.2019.12.010 URL
[15]	Parikh MP, Wadhwa V, Thota PN, et al. Outcomes as-sociated with timing of ERCP in acute cholangitis se-condary to choledocholithiasis[J]. J Clin Gastroenterol, 2018, 52(10):e97-e102. doi: 10.1097/MCG.0000000000000982 URL
[16]	Severance SE, Feizpour C, Feliciano DV, et al. Timing of cholecystectomy after emergent endoscopic retrograde cholangiopancreatography for cholangitis[J]. Am Surg, 2019, 85(8):895-899. pmid: 31560309
[17]	Cox MR, Budge JP, Eslick GD. Timing and nature of presentation of unsuspected retained common bile duct stones after laparoscopic cholecystectomy: a retrospective study[J]. Surg Endosc, 2015, 29(7):2033-2038. doi: 10.1007/s00464-014-3907-x URL
[18]	Aziret M, Karaman K, Ercan M, et al. Early laparoscopic cholecystectomy is associated with less risk of complications after the removal of common bile duct stones by endoscopic retrograde cholangiopancreatography[J]. Turk J Gastroenterol, 2019, 30(4):336-344. doi: 10.5152/tjg.2018.18272 URL
[19]	Lin Y, Su Y, Yan J, et al. Laparoendoscopic rendezvous versus ERCP followed by laparoscopic cholecystectomy in the management of cholecystocholedocholithiasis: a systemic review and meta-analysis[J]. Surg Endosc, 2020, 34(9):4214-4224. doi: 10.1007/s00464-020-07698-y pmid: 32533356

项目	研究组（n=98）	对照组（n=93）	P值
年龄（岁）	49.5±15.8	50.3±13.6	>0.05
男/女	45/53	43/50	>0.05
高血压	43（43.8）	39（41.9）	>0.05
糖尿病	34（34.6）	29（31.1）	>0.05
上腹痛	98（100）	93（100）	>0.05
黄疸	69（70.4）	62（66.6）	>0.05
丙氨酸转氨酶（U/L）	126.3±20.2	121.2±16.6	>0.05
肝外胆管结石数量（枚）	2.3±0.7	2.4±0.5	>0.05

项目	研究组（n=98）	对照组（n=93）	P值
手术时间（min）	73.3±16.5	85.1±15.3	<0.05
术中出血量（mL）	42.9±4.8	45.7±5.4	>0.05
术后住院时间（d）	5.2±1.1	11.3±2.8	<0.05
住院费用（人民币：元）	24 648.2±985.2	32 417.2±987.6	<0.05

项目	研究组（n=98）	对照组（n=93）	P值
总并发症	5（5.10）	5（5.38）	>0.05
急性轻型胰腺炎	2	3
胆漏	1	1
十二指肠乳头出血	1	1
胆道感染	1	0