Comparison of Laparoscopic Common Bile Duct Exploration and Endoscopic Retrograde Cholangiopancreatography in the Treatment of Bile Duct Stones and Analysis of Risk Factors for Postoperative Acute Pancreatitis.

OBJECTIVE

To compare the clinical efficacy and safety of laparoscopic common bile duct exploration and endoscopic retrograde cholangiopancreatography in the treatment of bile duct stones, and to analyze the related factors influencing postoperative acute pancreatitis.

METHODS

From March 2017 to June 2021, we recruited patients with bile duct stones to our study: 175 patients undergoing endoscopic retrograde cholangiopancreato-graphy and 147 patients undergoing laparoscopic common bile duct exploration. The operative time, intraoperative blood loss, conversion to laparotomy, postoperative exhaust time, hospitalization time, liver function before and after the operation, and the incidence of adverse events were compared. Logistic regression analysis was used to analyze the related factors influencing postoperative acute pancreatitis.

RESULTS

All patients were operated on successfully, with no conversion to laparotomy. Operative time, postoperative exhaust time, and hospitalization time were shorter, intraoperative blood loss was lower, and aspartate aminotransferase and alanine aminotransferase were higher in the endoscopic retrograde cholangiopancreato-graphy group compared with the laparoscopic common bile duct exploration group (P < .05). The endoscopic retrograde cholangiopancreatography group had a higher incidence of adverse events than the laparoscopic common bile duct exploration group (P < .05). After logistic regression analysis, white blood cell concentration, operative time, intraoperative blood loss, previous history of pancreatic disease, and endoscopic retrograde cholangiopancreatography operation all independently influenced the occurrence of acute pancreatitis.

CONCLUSION

Laparoscopic common bile duct exploration is our first choice for patients with bile duct stones who have no history of abdominal surgery, cardiac or pulmonary valve insufficiency, bile duct stenosis, and poor duodenal papilla function, as it can reduce the occurrence of postoperative complications and shorten rehabilitation. Further investigation of the factors that independently caused postoperative acute pancreatitis after stone removal is warranted.