Comparison Of LCBDE+PDC And ERCP/EST In The Treatment Of Extrahepatic Cholangiolithiasis After Cholecystectomy

Objective:To compare the curative effect of laparoscopic common bile duct exploration+primary duct closure(LCBDE+PDC)and endoscopic sphincterotomy(ERCP/EST)on extrahepatic cholangiolithiasis after cholecystectomy.Methods:The clinical data of patients with extrahepatic cholangiolithiasis after cholecystectomy admitted to Chizhou People’s Hospital from Jan.2017 to Sep.2022 were retrospectively analyzed.The patients were divided into LCBDE+PDC group(n=30)and ERCP/EST group(n=46).Results: There were no significant differences in preoperative general information including gender,age,diameter of common bile duct,preoperative complications between the two groups(P>0.05).There were no significant difference in postoperative lenth of hospital stay between the two groups(P=0.37).Comparing with the ERCP/EST group,the LCBDE+PDC group costs less hospitalization expenses [(14.03±3.32)RMB’000 v.s(22.88±6.75)RMB’000](P<0.05).residual stones were found in one patient following LCBDE+PDC,and was treated by choledocholithotomy with T-tube drainage,which was considered as surgical failure,and the operation successful ratio was 96.7%(29/30).In the ERCP/EST group,stone removel failure occurred in two patients,we chose ENBD retention drainage for elective ERCP in case of biliary tract injury and pancreatitis due to repeated operation,and the successful ratio of stone removel was 95.7%(44/46).Postoperative bile leakage occurred in 5 patients in LCBDE+PDC group(10.9%),and they recovered in short time after drainage treatment;pancreatitis emerged in 1 patient(2.2%),and improved following expectant treatment;there were no patients complicated with abdominal or incision bleeding.Stones recurred in 2 patients after 1 year follow-up(4.4%).9 patients was complicated with acute postoperative pancreatitis in the ERCP/EST group(19.6%),and gastrointestinal bleeding in 4 patients(8.7%),all these complications was improved or cured after expectant treatment;Stones recurred in 6 patients after 1 year follow-up.No death case occurred in the two groups,and there was significant difference in the ratio of postoperative complications(p<0.05).Conclusion: It is safe and feasible to carry out LCBDE+PDC or ERCP/EST to treat extrahepatic cholangiolithiasis after cholecystectomy,while the patients receiving LCBDE+PDC spent less with lower postoperative complications and oddis sphincter function remaining comparing with ERCP/EST,thus,LCBDE+PDC is priority for the patients with strong indications.