title: Synchronous vs sequential laparoscopic cholecystectomy for cholecystocholedocholithiasis.
abstract: OBJECTIVE
  To compare synchronous laparoscopic cholecystectomy (LC) combined with endoscopic sphincterotomy (EST) and sequential LC combined with EST for treating cholecystocholedocholithiasis.
  
  
  METHODS
  A total of 150 patients were included and retrospectively studied. Among these, 70 were selected for the synchronous operation, in which the scheme was endoscopic retrograde cholangiopancreatography combined with EST during LC. The other 80 patients were selected for the sequential operation, in which the scheme involved first cutting the papillary muscle under endoscopy and then performing LC. The indexes in the two groups, including the operation time, the success rate, the incidence of complications, and the length of the hospital stay, were observed.
  
  
  RESULTS
  There were no significant differences between the groups in terms of the numbers of patients, sex distribution, age, American Society of Anesthesiologists score, serum bilirubin, γ-glutamyl transpeptidase, mean diameter of common bile duct stones, and previous medical and surgical history (P = 0.54, P = 0.18, P = 0.52, P = 0.22, P = 0.32, P = 0.42, P = 0.68, P = 0.70, P = 0.47 and P = 0.57). There was no significant difference in the surgical operation time between the two groups (112.1 ± 30.8 min vs 104.9 ± 18.2 min). Compared with the sequential operation group, the incidence of pancreatitis was lower (1.4% vs 6.3%), the incidence of hyperamylasemia (1.4% vs 10.0%, P < 0.05) was significantly reduced, and the length of the hospital stay was significantly shortened in the synchronous operation group (3 d vs 4.5 d, P < 0.001).
  
  
  CONCLUSIONS
  For treatment of cholecystocholedocholithiasis, synchronous LC combined with EST reduces incidence of complications, decreases length of hospital stay, simplifies the surgical procedure, and reduces operation time.
authors.affiliation: Department of Gastroenterology, Yangzhou No. 1 People's Hospital, The Second Clinical School of Yangzhou University, Yangzhou 225000, Jiangsu Province, China.
authors.forename: Yan-Bing
authors.initials: YB
authors.lastname: Ding
authors.forename: Bin
authors.initials: B
authors.lastname: Deng
authors.forename: Xin-Nong
authors.initials: XN
authors.lastname: Liu
authors.forename: Jian
authors.initials: J
authors.lastname: Wu
authors.forename: Wei-Ming
authors.initials: WM
authors.lastname: Xiao
authors.forename: Yuan-Zhi
authors.initials: YZ
authors.lastname: Wang
authors.forename: Jian-Ming
authors.initials: JM
authors.lastname: Ma
authors.forename: Qiang
authors.initials: Q
authors.lastname: Li
authors.forename: Ze-Sheng
authors.initials: ZS
authors.lastname: Ju
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography / Q000379:methods; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D042883:Choledocholithiasis / Q000601:surgery* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic / Q000379:methods; D016896:Treatment Outcome
keywords: Cholecystolithiasis; Choledocholithiasis; Endoscopic retrograde cholangiopancreatography; Endoscopic sphincterotomy; Laparoscopic cholecystectomy