DYNAMIC CHANGES IN INFLAMMATORY INDICES AFTER LAPAROSCOPIC COMMON BILE DUCT EXPLORATION IN MALE AND FEMALE PATIENTS WITH COMPLEX COMMON BILE DUCT STONES

Common bile duct stones (CBDS) are among the most prevalent biliary tract diseases, with a higher incidence in women, and pose a significant global health challenge. If left untreated, CBDS can lead to severe inflammatory complications, including cholangitis, pancreatitis, and biliary cirrhosis. Laparoscopic common bile duct exploration (LCBDE) followed by laparoscopic cholecystectomy (LC) has become a widely adopted treatment approach, alongside advanced endoscopic retrograde cholangiopancreatography (ERCP) techniques. However, managing cholelithiasis accompanied by difficult common bile duct stones (DCBDS) remains particularly challenging. The LCBDE + LC approach has been shown to minimize surgical trauma and systemic inflammatory response, leading to faster recovery in patients with cholelithiasis accompanied by DCBDS. Despite these advancements, sex-based differences in post-LCBDE + LC systemic inflammatory response remain largely unexplored. Aim. The study purposed to evaluate and compare the dynamic changes in inflammatory markers between male and female patients with cholelithiasis accompanied by DCBDS undergoing LCBDE + LC. Methods. The study included 71 patients (24 males and 47 females) with cholelithiasis accompanied by DCBDS who underwent LCBDE + LC, with a mean age of 60.3 ± 1.9 years. White blood cell (WBC) counts and differentials were measured using a Mindray BC-2800 automatic hematological analyzer (Mindray, Shenzhen, China). Additionally, WBC-based inflammatory indices were calculated, including the neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), systemic inflammatory response index (SIRI), systemic immune-inflammation index (SII), and neutrophil-to-monocyte ratio (NMR). These indices were evaluated at three time points: before surgery, 24 h postoperatively, and upon discharge. Results. Preoperatively, median inflammatory index values were significantly higher in female patients with cholelithiasis accompanied by DCBDS compared to males: NLR, PLR, and NMR were 1.4 times higher, while SII – by 1.6. 24 h post-surgery, systemic inflammatory indices followed distinct patterns in male and female patients. In males, the median values of NLR and LMR remained unchanged, whereas SII and NMR increased 1.2-fold, PLR rose 1.5-fold, and SIRI decreased 1.3-fold. In contrast, females exhibited a decline in the median values of NLR, SIRI, and SII by 1.2-, 1.7-, and 1.3-fold, respectively. PLR and NMR remained stable, while LMR increased 1.4-fold. At discharge, male patients showed a marked increase in median inflammatory index values compared to baseline, ranging from 1.8- to 2.5-fold. In contrast, females demonstrated either unchanged values or an increase of approximately 30% relative to baseline. Conclusions. Female patients with cholelithiasis accompanied by DCBDS demonstrate a greater ability to resolve post-surgical inflammation compared to males.