Systematic Review Of Laparoscopic Choledocholithotomy Combined With Choledochoscopy And Open Surgery For Common Bile Duct Stones

BackgroundClinically, 15% to 18% of patients with gallstones have common bile duct stones. In the past, for such patients, we used abdominal cholecystectomy and common bile duct T tube drainage.Conventional open surgery for common bile duct showed reliable results, but cholecystectomy still has a lot of blindness. The rate of postoperative residual hepatolithiasis is up to 36.8% even in experienced hospitals.Intraoperative cholangioscopy can reduce the residual rate of bile duct stones, especially when we faced incarceration or basket easy trap of refractory bile duct stones; in that case, shock wave lithotripsy device in body was underwent before lithotripsy stone basket. This showed more significant effect, while avoiding the side injury during blind exploration and reducing reoperation rate of the biliary tract.It plays an important role to use cholangioscopy for improving the surgical treatment of hepatolithiasis. Currently laparoscopic cholecystectomy (LC) has become the "Gold standard". Common bile duct stones used to be a contraindication to laparoscopic surgery. In 1991 the first case of laparoscopic cholecystectomy incision with choledochofiberscope lithotomy was performed by Phllip. Since the 21st century, minimally invasive surgical techniques, especially laparoscopic techniques have seen rapid development and have great potential to replace the traditional open surgery in the above areas. Laparoscopic common bile duct, stone extraction choledochofiberscopy and T tube drainage, following the laparoscopic cholecystectomy (laparoscopic cholecystectomy, LC) is another leap forward after the laparoscopic surgery.ObjectiveMeta analysis was used to evaluate clinical effect treatment of common bile duct stones between laparoscopy combined with choledochoscopy and open open surgery. so as to provide some evidence based medicine for similar surgical patients to have a reasonable choice .MethodsWe searched the Chinese Journal Full-text database of science and echnology, the Chinese Journal Full-text database of Chinese biomedical literature database, PubMed, SCI, Cochrane Library, and other search engines, to include relevant cases into a cohort study of comparing laparoscopic bile duct into the mirror (hereinafter referred to as dual-mirror combination) with open gallbladder surgery, and Meta-analysis was conducted using RevMan 4.2.ResultsA total of six studies, 1040 patients were included.Meta analysis showed: double-mirror surgery group, compared with open surgery group, had no statistical difference in postoperative bile leak. But there was statistical difference in intraoperative blood loss, the recovery time of enterokinesia, postoperative hospital stay, operative time, reduced postoperative pain, postoperative residual stones, and wound infection.ConclusionThere was no difference in the rate of bile leak of treating common bile duct stones between double-mirror surgery group and open surgery group. But it cost less time to perform open surgery group than double-mirror surgery group. However, compared with open surgery group, double-mirror combination group show much better effect in intraoperative blood loss, shorter postoperative recovery time of intestinal function, shorter postoperative hospitalization stay and operative time, less postoperative pain and litter postoperative residual stones. In view of wound infection, the double-mirror combination group revealed a huge advantage.