Gallbladder stones are common, and about 10-20% of patients with gallbladder stones have a combination of common bile duct stones. The treatment of gallbladder stones alone is relatively simple and can be cured by cholecystectomy, but once combined with common bile duct stones, not only the patient suffers much more pain and even life threatening, but also the treatment plan is much more complicated. There are three treatment options: first, cesarean cholecystectomy + choledochotomy + T-tube drainage; second, laparoscopic cholecystectomy + choledochotomy + T-tube drainage; third, endoscopic ERCP choledochotomy + cholecystectomy (laparoscopic or cesarean). The following is an introduction to the indications, advantages and disadvantages of these three options.
I. Cesarean cholecystectomy + common bile duct extraction + T-tube drainage
It is a traditional and classical treatment plan, suitable for all kinds of gallbladder stones and common bile duct stones patients, with low treatment cost, but the disadvantages are
1.Surgery is very traumatic and cannot be used for some patients of advanced age, poor general condition and difficult to tolerate surgery.
2. Long treatment time and inconvenient life for the patient.
Patients have to be discharged with a drainage tube, i.e., T-tube, and then be hospitalized again after 1-2 months or longer. If there are residual common bile duct stones, choledochoscopy will be performed to remove the stones.
Second, laparoscopic cholecystectomy + common bile duct excision and stone extraction + T-tube drainage
It is suitable for patients with thick common bile duct and mild inflammation in the abdominal cavity. The advantages are less traumatic than caesarean section and faster recovery. Disadvantages are.
1. it cannot be used for those with a history of upper abdominal surgery and heavy abdominal adhesions.
2. like caesarean section, it cannot be used by patients who cannot tolerate the operation.
3, long treatment time, the need to discharge with tubes, the patient’s life is not convenient.
Endoscopic ERCP choledocholith extraction + cholecystectomy (laparoscopic or caesarean)
It is a treatment option that has been used more and more in recent years. First, a duodenoscope (like a gastroscope) is used to reach the duodenum through the mouth, esophagus, and stomach, find the opening of the common bile duct in the duodenum, insert a tube into the common bile duct, and after imaging the common bile duct stones, remove the stones with a lithotripsy mesh basket and lithotripsy balloon. Then laparoscopic or cesarean cholecystectomy is performed.
The advantages are.
1. Less invasive, the least invasive treatment option among the three treatment options. It is suitable not only for patients with general gallbladder stones combined with common bile duct stones, but also for patients with poor general condition.
2. short treatment time, no need to discharge with tubes.
Disadvantages are.
1, high cost.
2. difficult to remove stones by ERCP in patients with common bile duct full of stones, or with many stones in the common bile duct, large diameter, or who have undergone gastric surgery with type II anastomosis
3. Endoscopic ERCP itself has a certain incidence of complications, such as intestinal perforation, bleeding, pancreatitis, etc.
The above are general treatment options, which need to be selected according to the patient’s specific situation. For patients with small common bile duct stones and a small number of stones, they can also be removed by choledochoscopy, which does not require incision of the common bile duct and does not require a T-tube. It is also possible to remove the common bile duct stones and then suture the common bile duct directly. For patients who are in very poor condition, difficult to tolerate surgery, or in critical condition, they can also be treated first by endoscopic ERCP bile duct drainage and release of biliary obstruction to pass the dangerous period, and then the next treatment plan will be decided according to the patient’s physical condition.