Treatment of Common Bile Duct Stones

ABSTRACT Introduction: Common bile duct (CBD) stone is a common clinical situation, especially in Asia area. Laparotomy and laparoscopic surgical procedure are often used for treatment. This study compares outcomes of different surgical procedures treating for the disease. Methods/design: This is a prospective, randomized, controlled multicenter trial with three treatment arms. One group underwent laparoscopic cholecystectomy (LC) + laparoscopic CBD exploration (LCBDE) + intraoperative endoscopic nasobiliary drainage ENBD + primary closure of CBD. The other underwent preoperative endoscopic retrograde cholangiopancreatography (ERCP) and subsequent LC and the third arm underwent laparoscopic cholecystectomy (LC) + laparoscopic CBD exploration (LCBDE) + primary closure of CBD. The duration of the entire trial is two years including prearrangement, follow-up and analyses. Discussion: Despite the fact plenty evidences provided by meta-analyses suggests that these approaches would appear comparable. It is hopeful to fully address which would be the better approach with this RCT design.

Inclusion Criteria: Patients with age between 18 - 80 years. Patients diagnosed with gallstones. Patients diagnosed with common bile duct stone by one of the three exam (US、MRCP and CT). Patients diagnosed with common bile duct stone by intro-operative cholangiography or transcystic exploration. Patients understood the trial and accepted one of the three managements. Exclusion Criteria: Combined with Mirizzi syndrome and intrahepatic bile duct stones Previous EST/endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic biliary drainage (PTBD) History of upper abdominal surgery. Serious heart, brain, lung, metabolic diseases history. Pregnant women. Unwillingness or inability to consent for the study.