Laparoscopic common bile duct exploration vs endoscopic retrograde cholangiopancreatography for the treatment of difficult common bile duct stones: postsurgery inflammation and liver function.

BACKGROUND: The 2019 European Society of Gastrointestinal Endoscopy guidelines recommend advanced endoscopic techniques or laparoscopic surgery for the management of difficult common bile duct (CBD) stones (DCBDSs). A treatment approach that focuses on minimizing inflammation while preserving liver function may enhance decision-making and improve patient outcomes. This study aimed to compare clinical outcomes, inflammatory markers, and liver function tests (LFTs) in patients with cholelithiasis (CL) and concomitant DCBDSs who underwent either laparoscopic CBD exploration (LCBDE) followed by laparoscopic cholecystectomy (LC) or endoscopic retrograde cholangiopancreatography (ERCP) with subsequent LC.

METHODS: This retrospective study included 136 patients diagnosed with CL and concomitant DCBDSs who were divided into 2 groups based on the treatment approach: the single-stage LCBDE + LC group (n = 71) and the 2-stage ERCP + LC group (n = 65). The study compared the success rates of CBD clearance, residual stone rates, and complications (including cholangitis, pancreatitis, hyperamylasemia, and bile leakage). In addition, recovery indicators (postoperative hospital stay and time to first postoperative exhaust and defecation), inflammatory markers (hematological parameters, white blood cell-based inflammatory indices, and serum procalcitonin levels), and liver function indicators (LFTs and albumin-bilirubin score) were analyzed.

RESULTS: The CBD clearance rate was slightly higher, the residual stone rate was reduced by half, and the overall complication rate was 4 times lower in the single-stage group than in the 2-stage group. No cases of postoperative pancreatitis or hyperamylasemia were observed, and the incidence of cholangitis was 3.5 times lower after LCBDE + LC than after ERCP + LC. The single-stage group experienced a significantly shorter postoperative exhaust and defecation time and a reduced hospital stay. Furthermore, postoperative inflammatory markers were reduced, whereas liver function indicators were substantially better in the LCBDE + LC group than in the ERCP + LC group.

CONCLUSION: Our findings suggest that LCBDE + LC provides comparable efficacy in CBD clearance with ERCP + LC while offering the added benefits of fewer postoperative complications, reduced inflammation, and better preservation of liver function.