Comparison of one-step laparoscopy and two-step endolaparoscopy in the treatment of secondary choledocholithiasis: A multicenter retrospective clinical study

Abstract

BACKGROUND:

There are two minimally invasive ways of treating cholecystolithiasis combined with choledocholithiasis, but there remains some controversy regarding which technique is better, since they both have advantages and disadvantages. The one-step method involves laparoscopic cholecystectomy, laparoscopic common bile duct exploration, and primary close (LC $+$ LCBDE $+$ PC), while the two-step procedure consists of endoscopic retrograde cholangiopancreatography, endoscopic sphincterotomy, and laparoscopic cholecystectomy (ERCP $+$ EST $+$ LC).

OBJECTIVE:

This multicenter retrospective study aimed to analyze and compare the effects of the two techniques.

METHODS:

The data of patients who underwent either one-step LCBDE $+$ LC $+$ PC or two-step ERCP $+$ EST $+$ LC treatment for gallstones in the gallbladder and bile duct at the Shanghai Tenth People’s Hospital, Shanghai Tongren Hospital, and Taizhou Fourth People’s Hospital between January 1, 2015 and December 31, 2019 were collected, and the preoperative indicators of the two groups were compared.

RESULTS:

The surgical success rate of the one-step laparoscopic group was 96.23% (664/690), the transit abdominal opening rate was 2.03% (14/690), and there were 21 cases of postoperative bile leakage. The success rate of the two-step endolaparoscopic surgery was 78.95% (225/285), the transit opening rate was 2.46% (7/285), and there were 43 postoperative cases of pancreatitis and five of cholangitis. Postoperative cholangitis, pancreatitis, postoperative stone recurrence, postoperative hospitalization, and treatment costs were significantly lower ( $P<$ 0.05) in the one-step laparoscopic group than in the two-step endolaparoscopic group. However, the amount of intraoperative bleeding, the postoperative extraction time of the abdominal drainage tube, and the incidence of bile leakage were higher ( $P<$ 0.05) in the one-step laparoscopic group than in the two-step endolaparoscopic group.

CONCLUSION:

The two methods of treating choledocholithiasis combined with choledocholithiasis that were analyzed in this study were safe and effective, and each method had its own advantages.