Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2022; 10(30): 10931-10938
Published online Oct 26, 2022. doi: 10.12998/wjcc.v10.i30.10931
Clinical observation of laparoscopic cholecystectomy combined with endoscopic retrograde cholangiopancreatography or common bile duct lithotripsy
Hong Niu, Fei Liu, Yi-Bo Tian
Hong Niu, Department of Gastroenterology, Jincheng General Hospital, Jincheng 048000, Shanxi Province, China
Fei Liu, Department of General Surgery, Jincheng General Hospital, Jincheng 048000, Shanxi Province, China
Yi-Bo Tian, Department of Emergency, Jincheng General Hospital, Jincheng 048000, Shanxi Province, China
Author contributions: Tian YB designed the research study; Niu H performed the research; Liu F contributed new reagents and analytic tools; Niu H analyzed the data and wrote the manuscript; and all authors have read and approve the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Jincheng Hospital Institutional Review Board (Approval No. 2021LL1203).
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors report none of conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yi-Bo Tian, MHSc, Attending Doctor, Department of Emergency, Jincheng General Hospital, Chang’an Road, Beishidian, Jincheng 048000, Shanxi Province, China. tyb165363960@163.com
Received: May 16, 2022
Peer-review started: May 16, 2022
First decision: July 11, 2022
Revised: July 22, 2022
Accepted: September 12, 2022
Article in press: September 12, 2022
Published online: October 26, 2022
Abstract
BACKGROUND

The incidence of common bile duct (CBD) stones accounts for approximately 10%–15% of all CBD diseases. Approximately 8%–20% of these patients also have gallstones with heterogenous signs and symptoms.

AIM

To investigate the clinical effects of laparoscopic cholecystectomy (LC) combined with endoscopic retrograde cholangiopancreatography (ERCP) and LC with CBD excision and stone extraction in one-stage suture (LBEPS) for the treatment of gallbladder and CBD stones.

METHODS

Ninety-four patients with gallbladder and CBD stones were selected from our hospital from January 2018 to June 2021. They were randomly divided into study and control groups with 47 patients each. The study group underwent LC with ERCP, and the control group underwent LC with LBEPS. Surgery, recovery time of gastrointestinal function, complication rates, liver function indexes, and stress response indexes were measured pre- and postoperatively in both the groups.

RESULTS

The durations of treatment and hospital stay were shorter in the study group than in the control group. There was no significant difference between the one-time stone removal rate between the study and control groups. The time to anal evacuation, resumption of oral feeding, time to bowel sound recovery, and time to defecation were shorter in the study group than in the control group. The preoperative serum direct bilirubin (DBIL), total bilirubin (TBIL), and alanine aminotransferase (ALT) levels were insignificantly higher in the study group than that in the control group. A day after surgery, the postoperative serum DBIL, TBIL, and ALT levels were lower than their preoperative levels in both groups, and of the two groups, the levels were lower in the study group. Although the preoperative serum adrenocorticotrophic (ACTH), cortisol (COR), epinephrine (A), and norepinephrine (NE) levels were higher in the study group than that in the control group, these differences were not significant (P > 0.05). The serum ACTH, COR, A, and NE levels in both groups decreased one day after surgery compared to the preoperative levels, but the inter-group difference was statistically insignificant. Similarly, (91.79 ± 10.44) ng/mL, A, and NE levels were lower in the study group than in the control group. The incidence of complications was lower in the study group than in the control group.

CONCLUSION

LC combined with ERCP induces only a mild stress response; this procedure can decrease the risk of complications, improve liver function, and achieve and promote a faster recovery of gastrointestinal functions.

Keywords: Laparoscopic cholecystectomy, Endoscopic retrograde cholangiopancreatography, Choledochotomy with one-stage suture, Gallbladder stones, Common bile duct stones

Core Tip: Laparoscopic cholecystectomy (LC) combined with endoscopic retrograde cholangiopancreatography and LC combined with choledochotomy and lithotripsy are commonly used for the treatment of gallstones; in this study, we further investigated the efficacy and safety of these procedures.