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Background <p>Both laparoscopic common bile duct exploration with primary suture (LBEPS) and endoscopic retrograde cholangiopancreatography (ERCP) combined with laparoscopic cholecystectomy (LC) are established approaches for the treatment of concurrent cholecystocholedocholithiasis. While ERCP + LC remains widely utilized, LBEPS offers distinct advantages as a single-stage, minimally invasive procedure with shorter operative time and expedited recovery.</p> Methods <p>This retrospective study compared clinical outcomes between patients undergoing LBEPS (<i>n</i> = 226) and those receiving ERCP + LC (<i>n</i> = 144) at our institution from December 2018 to November 2025. Baseline characteristics, perioperative parameters, complications, and follow-up data were analyzed.</p> Results <p>Complete stone clearance (100%) was achieved in both groups, with no conversions to open surgery. One postoperative death occurred in the ERCP + LC group (0.69%). Relative to ERCP + LC, LBEPS patients were older, had wider common bile ducts, and presented with a higher prevalence of preoperative acute cholangitis (all <i>P</i> &lt; 0.05), yet exhibited lower baseline AST and ALT levels (<i>P</i> &lt; 0.05). Following baseline adjustment, LBEPS demonstrated significantly superior postoperative recovery of ALT and AST (<i>P</i> &lt; 0.05). ERCP + LC was associated with shorter general anesthesia time, lower postoperative total bilirubin, direct bilirubin, white blood cell count, and neutrophil count, but higher platelet counts and total hospitalization costs (all <i>P</i> &lt; 0.05). Overall complication rates were comparable between groups (8.85% vs. 7.64%, <i>P</i> &gt; 0.05). LBEPS complications predominantly comprised bile leakage and intra-abdominal infection (3.54% each), whereas ERCP + LC was marked by higher rates of acute pancreatitis (4.17%) and intra-abdominal infection (2.78%). During follow-up, no significant differences emerged in stone recurrence (1.33% vs. 1.39%) or cholangitis incidence (0.88% vs. 0.69%), and no bile duct strictures were observed in either cohort.</p> Conclusion <p>Both LBEPS and ERCP + LC are safe, effective, and confer distinct benefits, achieving equivalent stone clearance and long-term outcomes. Individualized treatment selection should be guided by patient-specific clinical profiles.</p>

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Laparoscopic common bile duct exploration and primary suture versus ERCP combined with laparoscopic cholecystectomy for choledocholithiasis: a retrospective comparative study

  • 期刊论文

  • 发表日期：

    2026年4月2日

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  • Fei Liu,
  • Xiao-qin Liu,
  • Dai-jiao Gu,
  • Jun-jiang Pan,
  • Zong-hua Chen,
  • Hai-wen Ye

摘要

Background

Both laparoscopic common bile duct exploration with primary suture (LBEPS) and endoscopic retrograde cholangiopancreatography (ERCP) combined with laparoscopic cholecystectomy (LC) are established approaches for the treatment of concurrent cholecystocholedocholithiasis. While ERCP + LC remains widely utilized, LBEPS offers distinct advantages as a single-stage, minimally invasive procedure with shorter operative time and expedited recovery.

Methods

This retrospective study compared clinical outcomes between patients undergoing LBEPS (n = 226) and those receiving ERCP + LC (n = 144) at our institution from December 2018 to November 2025. Baseline characteristics, perioperative parameters, complications, and follow-up data were analyzed.

Results

Complete stone clearance (100%) was achieved in both groups, with no conversions to open surgery. One postoperative death occurred in the ERCP + LC group (0.69%). Relative to ERCP + LC, LBEPS patients were older, had wider common bile ducts, and presented with a higher prevalence of preoperative acute cholangitis (all P < 0.05), yet exhibited lower baseline AST and ALT levels (P < 0.05). Following baseline adjustment, LBEPS demonstrated significantly superior postoperative recovery of ALT and AST (P < 0.05). ERCP + LC was associated with shorter general anesthesia time, lower postoperative total bilirubin, direct bilirubin, white blood cell count, and neutrophil count, but higher platelet counts and total hospitalization costs (all P < 0.05). Overall complication rates were comparable between groups (8.85% vs. 7.64%, P > 0.05). LBEPS complications predominantly comprised bile leakage and intra-abdominal infection (3.54% each), whereas ERCP + LC was marked by higher rates of acute pancreatitis (4.17%) and intra-abdominal infection (2.78%). During follow-up, no significant differences emerged in stone recurrence (1.33% vs. 1.39%) or cholangitis incidence (0.88% vs. 0.69%), and no bile duct strictures were observed in either cohort.

Conclusion

Both LBEPS and ERCP + LC are safe, effective, and confer distinct benefits, achieving equivalent stone clearance and long-term outcomes. Individualized treatment selection should be guided by patient-specific clinical profiles.