Comparison Of Postoperative Complications And Stone Recurrence Between Three Minimally Invasive Treatment Options For Choledocholithiasis Coexisted With Cholecystolithiasis

Purpose: Three different minimally invasive treatments for clinical cases of choledocholithiasis with cholecystolithiasis were analyzed and compared,by using EST+LC(Endoscopic Sphincetomy plus Laparoscopic Cholecystectomy,hereinafter referred to as EST/LC),LC+LTDBDE(Laparoscopic Cholecystectomy plus Laparoscopic Transductal Common Bile Duct Exploration,hereinafter referred to as TD),and LC+LTCBDE(Laparoscopic Cholecystectomy plus Laparoscopic Transcystic Common Bile Duct Exploration,hereinafter referred to as TC),in patients with postoperative complications and prognosis,including postoperative complications rate and postoperative stone recurrence rate,and independent risk factors for recurrence of common bile duct stones.Methods: We reviewed a large number of highly valuable research documents,formulated inclusion and exclusion criteria,and collected clinical cases in the circumstance of strict accordance with the inclusion criteria.Clinical data of 154 patients with choledocholithiasis with cholecystolithiasis from January 2013 to June 2017 were collected.All these patients received minimally invasive surgical treatment in our hospital and recovered before hospital discharge.The patients were grouped according to the minimally invasive treatment plans,including 34 cases in EST/LC group,98 in TD group and 22 in TC group.Then surgical effectiveness was compared,involved operation length,intraoperative blood loss,and postoperative hospital stay.Incidence of postoperative complications,including postoperative biliary fistula,celiac hemorrhage,biliary tract infection,abdominal infection,postoperative pancreatitis,and incisional hernia,were compared among the three groups.Patients discharged from the hospital were told to keep on a strict follow-up strategy,at least 2 years follow-up period including an outpatient or hospital review once every 3 months or a telephone follow-up in every 6 months for nonfollow-up patients,for us to compare prognosis,surgical outcomes and stone recurrence information.Results: There was no significant difference in the basic information,together with gender,age,cholangitis,jaundice,ASA score,multiple choledocholithiasis and dilatation of common bile duct between the groups(p> 0.05).The successful rate was 97.1%(33 cases)in EST/LC group,98.0%(96 cases)in TD group,and 100%(22 cases)in TC group.No significant difference was found in success rates among three groups of minimally invasive surgical treatment(p> 0.05).There were significant differences in operative length between the three groups(p <0.05).The length of laparotomy in EST/LC group was shorter than that of the other two surgical groups(p <0.05).Difference of postoperative hospital stay was observed and there was shortened after TC.There was no significant difference between the three groups of surgical patients bleeding(p> 0.05).Among the selected cases,the incidence of surgical complications in EST/LC group was 20.6%(7 cases),in TD group 9.2%(9 cases)and in TC group 9.1%(2 cases).There was no significant difference in the overall complication rates between the three groups(p> 0.05).The incidence of post-operative pancreatitis in EST/LC group was significantly higher than that in other minimally invasive treatment groups(p <0.05).Three groups' complications of postoperative biliary fistula,abdominal bleeding,biliary tract infection,abdominal infection and incisional hernia were no significant difference(p> 0.05).There was no significant difference in the recurrence rate between the three groups(p> 0.05).Univariate and multivariate analysis showed that preoperative cholangitis and multiple common bile duct stones(stones number ? 2)were independent risk factors for recurrence of common bile duct stones(p <0.05).Conclusion: There is no significant difference in success rates,complication rates and recurrence rates between the three minimally invasive approaches.TC method can bring shorter hospital stay for patients with choledocholithiasis plus cholecystolithiasis,and EST/LC approach can shorten the length of operation.Preoperative cholangitis and multiple common bile duct stones(stones number ? 2)may be the independent risk factors for the recurrence of common bile duct stones.