Comparison Of The Efficacy Of Laparoscopic Biliary Exploration And ERCP For Common Bile Duct Stones In Post-cholecystectomy

Objective:By retrospective analysis,we evaluate the efficacy of laparoscopic biliary exploration and ERCP in the treatment of common bile duct stones in-post cholecystectomy to explore best treatment strategy.Methods:Collecting 167 cases of choledocholithiasis with previous history of cholecys-tectomy admitted to the Second Affiliated Hospital of Nanchang University from September 2015 to June 2017,107 eligible cases screened by inclusion and exclusion criteria.According to the different surgical methods,it was divided into two groups,including 65 cases in LCBDE group and 42 cases in ERCP group.The differences in the success rate of operation,stone clearance rate,operation time,hospitalization cost,length of stay,postoperative complications,and stone recurrence rate were compared between the two groups.Results:In the LCBDE group,the success rate was 95.4%.There were 3 cases of conversion to laparotomy,and the success rate of ERCP group was 95.2%,2 cases failed to get stone and change to LCBDE.There was no significant difference in success rate between the two methods(P=0.97).There were no residual stones in the LCBDE group.The stone clearance rate was 100%.In the ERCP group,there was 1case of postoperative stone residue and the stone clearance rate was 97.6%.However,there was no significant difference between the two groups(P=0.21).Compared with LCBDE group,the postoperative hospitalization time of ERCP group was shorter(5.9±2.4d vs 7.3±2.9d,P<0.05),hospitalization cost was less(13682.6±2774.8 yuan vs 27388.4±3623.5 yuan,P<0.05),and shorter in operation time(51.3±18.2 min vs132.9±42.5 min,P<0.05).No deaths during perioperative period in both groups.In the LCBDE group,there were 6 cases of complications,including 3 cases of bile leakage and 1 cases of intra-abdominal infection which was cured by conservative treatment,besides 2 cases of intraoperative intestinal injury were successfully repaired by laparoscopic surgery result to no postoperative intestinal leakage occurred.In the ERCP group,there were 7 cases of complication,including 1 case of duodenal perforation cured by surgery operation,3 cases of acute pancreatitis,1 case of hemorrhage,and 2 cases of intra-abdominal infection all were cured by conservative treatment.There was no significant difference in the recent complications between the two groups(P=0.25).Compared with the LCBDE group,the incidence of postoperative acute pancreatitis in the ERCP group was higher,with a statistically significant difference(P=0.03).In the LCBDE group,there were 2 cases of recurrence of stones after operation,and the recurrence rate was 3.1%.In the ERCP group,recurrence of stones occurred in 7 cases and the recurrence rate was 16.7%.There was a significant difference between the two groups(P=0.01).Conclusion:For the choledocholithiasis in-post cholecystectomy,ERCP is easy to removal stones,rapid postoperative recovery,lower cost,better efficacy in the near future,However,compared with ERCP,the incidence of recurrence of stones after laparoscopic biliary exploration is low.Both surgical methods have their own advantages.The appropriate surgical method should be selected according to the specific conditions of the patient.