Two minimally invasive surgical approaches for the treatment of common bile duct stones with gallbladder stones: a retrospective study

To compare the clinical outcomes of laparoscopic trans-cystic common bile duct exploration combined with cholecystectomy (LTCBDE+LC) versus endoscopic retrograde cholangiopancreatography combined with laparoscopic cholecystectomy (ERCP+LC) in the treatment of gallbladder stones combined with common bile duct stones. A retrospective analysis was conducted on 72 patients (29 in the LTCBDE+LC group and 43 in the ERCP+LC group) admitted to Nanchuan Hospital Affiliated to Chongqing Medical University from February 2023 to July 2024. Intraoperative and postoperative indicators, including operative time, intraoperative blood loss, hospital stay, cost, liver function recovery, and complications, were compared between the two groups. The LTCBDE+LC group demonstrated a significantly shorter hospital stay (8.69±3.19 days vs. 11.53±3.57 days, P<0.01) and significantly lower cost (29,842±7,954 CNY vs. 38,106±10,307 CNY, P<0.01), while preserving Oddi sphincter function. The ERCP+LC group had a significantly shorter operative time (140.23±42.88 min vs. 195.00±67.08 min, P<0.01) and a more significant reduction in postoperative ALT and AST levels (P<0.05). There was no statistically significant difference in the complication rates between the two groups. LTCBDE+LC offers advantages in reducing hospitalization duration, cost, and preserving physiological function, whereas ERCP+LC is more suitable for cases requiring rapid biliary decompression. Surgical strategies should be individualized based on patient characteristics and available technical resources.