Association of Laparoscopic Methods and Clinical Outcomes of Cholecystolithiasis Plus Choledocholithiasis: A Cohort Study.

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Background

Various surgical methods are available for cholecystolithiasis plus choledocholithiasis. The objective of this study is to explore the association between laparoscopic methods and clinical outcomes of cholecystolithiasis plus choledocholithiasis.

METHODS

This cohort study retrospectively included patients who underwent laparoscopic surgery for cholecystolithiasis plus choledocholithiasis at our hospital (January 2017 to March 2021). The primary outcome was bile leakage.

RESULTS

Totally 127 patients were enrolled. The time to get out of bed and the indwelling duration of the abdominal drainage tube in the patients who underwent laparoscopic cholecystectomy+lithotomy of common bile duct+common bile duct primary suture+endoscopic nasobiliary drainage were higher than the endoscopic retrograde cholangiopancreatography+laparoscopic cholecystectomy group, without differences in the laparoscopic common bile duct exploration group (all P < .05). All indexes decreased in the 3 groups after surgery (all P < .01). On the first day after surgery, only white blood cells (P < .001) and gamma-glutamyl transferase (P = .045) showed significant differences among the different surgical methods. The incidence of biliary leakage (P = .001) was higher in laparoscopic cholecystectomy+lithotomy of common bile duct+common bile duct primary suture+endoscopic nasobiliary drainage, while the occurrence of hyperamylasemia was higher with endoscopic retrograde cholangiopancreatography+laparoscopic cholecystectomy (P = .001). Compared with laparoscopic cholecystectomy+lithotomy of common bile duct+common bile duct primary suture+endoscopic nasobiliary drainage, laparoscopic common bile duct exploration was associated with fewer bile leakage (RR = 0.03, 95% CI: 0.003-0.37).

CONCLUSION

Compared with laparoscopic cholecystectomy+lithotomy of common bile duct+common bile duct primary suture+endoscopic nasobiliary drainage, laparoscopic common bile duct exploration was associated with bile leakage.