Treatment for recurrent choledocholithiasis: endoscopic? or laparoscopic? A prospective cohort study

Yong Zhou; Wen-Zhang Zha; Ye-Peng Zhang; Fu-Ming Xuan; Hong-Wei Wang; Xu-Dong Wu

doi:10.1007/s00464-024-11436-z

Treatment for recurrent choledocholithiasis: endoscopic? or laparoscopic? A prospective cohort study

Surg Endosc. 2024 Dec 2. doi: 10.1007/s00464-024-11436-z. Online ahead of print.

Authors

Yong Zhou¹, Wen-Zhang Zha¹, Ye-Peng Zhang², Fu-Ming Xuan¹, Hong-Wei Wang¹, Xu-Dong Wu³

Affiliations

¹ Department of General Surgery, Yancheng First Hospital, Affiliated Hospital of Nanjing University Medical School, Yancheng, Jiangsu, China.
² Department of General Surgery, Nanjing Jiangbei Hospital, Nanjing, Jiangsu, China.
³ Department of Gastroenterology, Yancheng First Hospital, Affiliated Hospital of Nanjing University Medical School, 66 South Renmin Road, Yancheng, 224005, Jiangsu, China. hnjsycwxd@163.com.

PMID: 39623176
DOI: 10.1007/s00464-024-11436-z

Abstract

Background: Endoscopic and laparoscopic techniques are crucial for management of bile duct stone.

Objective: The aim of this study was to share our initial experiences with endoscopic and laparoscopic treatments for recurrent choledocholithiasis, with a particular focus on long-term complications.

Methods: From January 2014 to June 2017, a total of 153 patients with recurrent common bile duct stones were prospectively recruited in this study. Patients were scheduled for either an endoscopic procedure (ERCP/EST group, n = 84), or a laparoscopic procedure (LCBDE group, n = 69). Data were collected on comorbid conditions, presenting symptoms, bile duct clearance, and the incidence of both short-term and long-term complications.

Results: Patients in ERCP/EST group had a stone clearance rate comparable to that of the LCBDE group (94.2% vs 91.7%, p = 0.549). Minor (Clavien-Dindo grade 1 and 2) and major short-term complications (Clavien-Dindo grade 3 and above) were similar between patients in two groups (ERCP/EST group 17.9% versus LCBDE group 26.1%, and ERCP/EST group 7.1% versus LCBDE group 5.8%, p = 0.227 and p = 0.740, respectively). Patients in the ERCP/EST group had a shorter stone free interval than patients in the LCBDE group (28.5 ± 14.7 months versus 43.3 ± 17.8 months, p = 0.029). During a mean follow-up period of 67.0 months, more patients in the ERCP/EST group experienced stone recurrence compared to those in the LCBDE group (26.1% vs 11.6%, p = 0.020). In the ERCP/EST group, 45.5% (10/22) of the recurrent cases experienced more than two recurrences, with three patients requiring choledochojejunostomy due to repeated recurrence. Among patients with a non-dilated common bile duct (d ≤ 8 mm), both groups had comparable short-term and long-term complication rates (p = 0.151 and p = 0.404, respectively).

Conclusions: Laparoscopic treatment is a safe and effective option for patients with recurrent choledocholithiasis, extending the stone free interval, reducing the likelihood of stone recurrence, and highlighting benefits of minimally invasive surgery.

Keywords: Choledocholithiasis; Common bile duct exploration; ERCP/EST; Stone recurrence; endoscopic treatment; laparoscopic treatment.

Abstract

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