One-stage laparoscopic versus two-stage endoscopic followed by laparoscopic treatment for cholecystolithiasis complicated with choledocholithiasis

Abstract

Objective To compare the clinical efficacy of one-stage laparoscopic cholecystectomy (LC) plus laparoscopic common bile duct exploration (LCBDE) with primary suture (PS) versus two-stage endoscopic retrograde cholangiopancreatography (ERCP)/endoscopic sphincterotomy(EST) followed by LC in treatment of cholecystolithiasis complicated with choledocholithiasis. Methods The clinical data of 171 patients with cholecystolithiasis complicated with choledocholithiasis, who underwent minimally invasive surgical treatment from January 2016 to December 2017, were retrospectively analyzed. Of these patients, 90 underwent one-stage LC+ LCBDE+ PS (the one-stage group), and 81 underwent two-stage ERCP/EST followed by LC (the two-stage group). The main clinical variables between the two groups of patients were compared. Results The surgical success rates (94.4% vs. 95.1%), residual stone rates (3.3% vs. 4.9%) and incidences of postoperative complications (6.7% vs.8.6%) showed no significant difference (all P>0.05) between the one-stage and two-stage groups. Compared with the two-stage group, the operative time was shorter (110.4 vs. 135.7 min), the length of postoperative hospital stay was shorter (3.3 vs. 7.1 d) and the total hospitalization cost was reduced (22 756.2 vs. 31 429.3 yuan) in the one-stage group. The incidence of long-term complications (2.2% vs.9.9%) in the one-stage group was also lower than that in the two-stage group (both P<0.05). Conclusions Both one-stage LC+ LCBDE+ PS and two-stage ERCP/EST+ LC are safe and effective in the treatment of cholecystolithiasis complicated with choledocholithiasis. One-stage LC+ LCBDE+ PS shows obvious advantages in hospitalization stay, hospitalization cost and in the preservation of function of the Oddi sphincter, and therefore should be the first choice in most cases. Key words: Cholecystolithiasis; Choledocholithiasis; Cholecystectomy, Laparoscopic; Cholangiopancreatography, endoscopic retrograde