Efficacy and safety of laparoscopic common bile duct exploration with primary closure and intraoperative endoscopic nasobiliary drainage for choledocholithiasis combined with cholecystolithiasis

Abstract

Background The need for intraoperative endoscopic nasobiliary drainage during laparoscopic cholecystectomy and laparoscopic common bile duct exploration with primary closure is controversial in the treatment of cholecystolithiasis combined with choledocholithiasis. The aim of this study was to evaluate the safety and efficacy of laparoscopic cholecystectomy + laparoscopic common bile duct exploration + intraoperative endoscopic nasobiliary drainage + primary closure (LC + LCBDE + IO-ENBD + PC). The safety of different intubation methods in IO-ENBD was also evaluated. Method From January 2018 to January 2022, 168 consecutive patients with cholecystolithiasis combined with choledocholithiasis underwent surgical treatment in our institution. Patients were divided into two groups: group A (n = 96) underwent LC + LCBDE + IO-ENBD + PC and group B (n = 72) underwent LC + LCBDE + PC. Patient characteristics, perioperative indicators, complications, stone residual, and recurrence rates were analyzed. Group A was divided into two subgroups. In group A1, the nasobiliary drainage tube was placed in an anterograde way, and in group A2, nasobiliary drainage tube was placed in an anterograde–retrograde way. Perioperative indicators and complications were analyzed between subgroups. Results No mortality in the two groups. The operation success rates in groups A and B were 97.9% (94/96) and 100% (72/72), respectively. In group A, two patients were converted to T-tube drainage. The stone clearance rates of group A and group B were 100% (96/96) and 98.6% (71/72), respectively. Common bile duct diameter was smaller in group A [10 vs. 12 mm, P < 0.001] in baseline data. In perioperative indicators, group A had a longer operation time [165 vs.135 min, P < 0.001], but group A had a shorter hospitalization time [10 vs.13 days, P = 0.002]. The overall complications were 7.3% (7/96) in group A and 12.5% (9/72) in group B. Postoperative bile leakage was less in group A [0% (0/96) vs. 5.6% (4/72), P = 0.032)]. There were no residual and recurrent stones in group A. And there were one residual stone and one recurrent stone in group B (all 1.4%). The median follow-up time was 12 months in group A and 6 months in group B. During the follow-up period, 2 (2.8%) patients in group B had a mild biliary stricture. At subgroup analysis, group A1 had shorter operation time [150 vs. 182.5 min, P < 0.001], shorter hospitalization time [9 vs. 10 days, P = 0.002], and fewer patients with postoperative elevated pancreatic enzymes [32.6% (15/46) vs. 68% (34/50), P = 0.001]. Conclusion LC + LCBDE + IO-ENBD + PC is safer and more effective than LC + LCBDE + PC because it reduces hospitalization time and avoids postoperative bile leakage. In the IO-ENBD procedure, the antegrade placement of the nasobiliary drainage tube is more feasible and effective because it reduces the operation time and hospitalization time, and also reduces injury to the duodenal papilla.

Comparison between the Laparoscopic and Intraoperative Endoscopic Management of Choledocholithiasis: Systematic Review

“…The included investigations compared the laparoscopic common bile duct exploration combined (LCBDE) to the laparoscopic cholecystectomy (LC) combined with intraoperative endoscopic sphincterotomy (IOEST). The success rates in both interventions were similar; however, only two studies reported that LCBDE had higher success rates than LC-IOEST (ElGeidie et al, 2011b;Zhang et al, 2022). Most studies reported more complications in the LC-IOEST except for two investigations (González et al, 2016;Zhang et al, 2022).…”

“…The success rates in both interventions were similar; however, only two studies reported that LCBDE had higher success rates than LC-IOEST (ElGeidie et al, 2011b;Zhang et al, 2022). Most studies reported more complications in the LC-IOEST except for two investigations (González et al, 2016;Zhang et al, 2022). The LC-IOEST was found to reduce the duration of posthospital stay, except for one study reported by ElGeidie et al (2011b).…”

“…A total of 8 studies were included in this review, with 3045 patients who underwent laparoscopic and intraoperative endoscopic interventions for choledocholithiasis. Four studies are prospective randomized trials (Hong et al, 2006;ElGeidie et al, 2011a,b;González et al, 2016), three are retrospective cohort studies (Wei et al, 2003;Vakayil et al, 2020;Zhang et al, 2022), and one is randomized control trial (Poh et al, 2016). Three studies were conducted in China (Wei et al, 2003;Hong et al, 2006;Zhang et al, 2022), two in Egypt (ElGeidie et al, 2011a, b), one in Australia (Poh et al, 2016), and one in the USA (Vakayil et al, 2020).…”

“…Four studies are prospective randomized trials (Hong et al, 2006;ElGeidie et al, 2011a,b;González et al, 2016), three are retrospective cohort studies (Wei et al, 2003;Vakayil et al, 2020;Zhang et al, 2022), and one is randomized control trial (Poh et al, 2016). Three studies were conducted in China (Wei et al, 2003;Hong et al, 2006;Zhang et al, 2022), two in Egypt (ElGeidie et al, 2011a, b), one in Australia (Poh et al, 2016), and one in the USA (Vakayil et al, 2020). The included investigations compared the laparoscopic common bile duct exploration combined (LCBDE) to the laparoscopic cholecystectomy (LC) combined with intraoperative endoscopic sphincterotomy (IOEST).…”

Laparoscopic transcystic common bile duct exploration following prior gastrectomy: the safety and feasibility Running head: Laparoscopic transcystic common bile duct exploration

“…LCBDE is a common surgical method for the treatment of gallstones and CBD stones, but about 15% of patients with T-tube drainage will have complications such as water and sodium electrolyte disorders, biliary peritonitis after T-tube removal, and T-tube displacement [17][18][19] . At present, the literature is more and more inclined to primary suture [20][21][22][23] .…”