Application of laparoscopy, choledochoscopy, and duodenoscopy in the treatment of gallstones with choledocholithiasis.

BACKGROUND

Both endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic common bile duct exploration (LCBDE) have advantages and disadvantages. However, few surgeons integrate the strengths of both approaches to manage common bile duct stones.

MATERIALS AND

METHODS

We retrospectively analyzed the clinical data of 40 patients with gallbladder stones complicated by common bile duct stones, all of whom were treated by our treatment group between June 2024 and December 2024 in the Department of Hepatobiliary Surgery, Wuhan Central Hospital. Based on the surgical approach, the patients were divided into an experimental group (n = 30, combined use of laparoscopy, choledochoscopy, and duodenoscopy) and a control group (n = 10, ERCP followed by laparoscopic cholecystectomy). Data were collected in terms of demographic characteristics (age, gender, body mass index), intraoperative variables (operative time, estimated blood loss, and width of the common bile duct), and postoperative variables (time for postoperative gas passage, postoperative hospital stay, and complications).

RESULTS

In the experimental group, the mean age of the patients was 63 years. The mean operative time was 152 min. The mean estimated blood loss was 46 mL. Two patients (6.7%) suffered from postoperative pancreatitis. In one patient, the condition was caused by intraoperative stone extraction manipulation. The condition of the two patients improved after symptomatic treatment for pancreatitis was administered. One patient (3.3%) suffered from biliary fistula. Compared with the control group, hospital stay was significantly shorter in the experimental group; however, there was an increase in operative blood loss and operative time. No significant differences were found in the other indices.

CONCLUSION

In the management of gallbladder stones with common bile duct stones, the "single-stage triple-endoscopic approach" represents a minimally invasive treatment with high clinical applicability. It is as safe and effective as traditional treatment regimens, and both ERCP and LCBDE have their own advantages.