Single-stage Versus Two-stage Management Of Common Bile Duct Stone (CBDS)-related Non-severe Acute Cholangitis

Objective:To compare the clinical efficacy of single-staged laparoscopic cholecystectomy(LC)and laparoscopic common bile duct exploration(LCBDE)with two-staged endoscopic retrograde cholangiopancreatography(ERCP)followed by LC in treatment of nonsevere acute cholangitis complicated with common bile duct stone.Methods: A retrospective study was conducted on 132 patients with nonsevere acute cholangitis complicated with common bile duct stones and gallbladder stones who underwent treatment at the Second Affiliated Hospital of Fujian Medical University from January 2015 to December 2018.Patients were divided into two groups according to surgical patterns: ERCP + LC Group(endoscopic retrograde cholangiopancreatography + laparoscopic cholecystectomy,n = 65)and LC + LCBDE Group(laparoscopic cholecystectomy + common bile duct exploration,n = 67).The clinical time,the average amount of surgical bleeding,the postoperative abdominal drainage time,the postoperative hospital stay,the postoperative complication rate and the hospitalization cost between the two groups were compared and analyzed.Results: There were no significant differences between the two groups in gender composition,age,major clinical manifestations,severity of acute cholangitis,accompanying disease,number of common bile duct stones,common bile duct diameter,white blood cell count,transaminase,and bilirubin.(p>0.05).And there were no significant differences in intraoperative blood loss,the pathologic type of gallbladder and in postoperative hospital stay.Compared with LC + LCBDE group,the length of operative time(92.22 ± 11.19 min vs.103.45 ± 11.50 min,p= 0.000)and abdominal drainage time in ERCP + LC group(2.77 ± 0.90 d vs.5.78 ± 1.06 d,p = 0.000)was shorter,however,the hospitalization cost of ERCP + LC group was higher than that of LC + LCBDE group(36506.35 ± 1837.05 vs.31040.30 ±1900.34,p =0.000).In Postoperative complications,there were no mortality and major bile duct injury in both two groups.And there were no significant differences were noted in overall incidence of complications,residual stone rate,in incidence of postoperative pancreatitis and pulmonary infection between the two groups(p>0.05).The incidence of hyperamylasemia was significantly higher in ERCP + LC group(10.77% vs.1.49%,p= 0.026),but the incidence of bile leak was significantly higher in LC + LCBDE group(8.96% vs.0,p= 0.028).And there were no statistically significant differences between the two groups in terms of stone recurrence,reflux cholangitis,bile duct stenosis and bile duct carcinoma during postoperative follow-up(p>0.05).Conclusion: Single-staged LC + LCBDE is as safe and effective as two-staged ERCP + LC for the treatment of patients with nonsevere acute cholangitis complicated with common bile duct stones,and either of them can be selected according to the individual patient’s condition.