title: Optimal selection of methods for mini-invasive treatment of extrahepatic bile duct stones.
abstract: OBJECTIVE
  This study aims to identify the optimal mini-invasive treatment for extrahepatic bile duct stones.
  
  
  METHODS
  One hundred and seventy eight patients with EHBD stones were randomized into 4 groups: laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) plus T-tube drainage (group LT), LC and LCBDE with endonasobiliary drainage (ENBD) tube (group LE), and endoscopic sphincterotomy with ENBD followed by LC (group EE) and T-tube drainage of open CBDE (group OT). Demographic data, perioperative findings, postoperative outcomes, hospital expense, gastrointestinal quality of life index (GIQLI) scores and cost per quality-adjusted life year (QALY) were analyzed.
  
  
  RESULTS
  The operating time was longest in group EE. There was less bleeding in group OT and EE. Group LE and EE had shorter hospital stay and recovery time of intestinal motility. The postoperative white blood cell count and serum C-reaction protein level were higher in group LT and OT. Postoperatively, the mean GIQLI scores in group LE and EE were higher. Mean cost were highest in group EE. Patients in group LE had lowest cost per QALY.
  
  
  CONCLUSIONS
  The modified laparoscopic procedure, LC combined with LCBDE followed by a primary closure over the ENBD tubes, appears to be the best option for patients with EHBD stones.
authors.forename: Wen Ming
authors.initials: WM
authors.lastname: Feng
authors.forename: Ying
authors.initials: Y
authors.lastname: Bao
authors.forename: Cheng Wu
authors.initials: CW
authors.lastname: Tang
authors.forename: Mao Yun
authors.initials: MY
authors.lastname: Fei
authors.forename: Hui Hui
authors.initials: HH
authors.lastname: Guo
authors.forename: Yu Long
authors.initials: YL
authors.lastname: Tao
authors.forename: Tao
authors.initials: T
authors.lastname: Xue
authors.forename: Hui
authors.initials: H
authors.lastname: Gong
authors.forename: Ge
authors.initials: G
authors.lastname: Cui
authors.forename: Yao
authors.initials: Y
authors.lastname: Wang
mesh_terms: D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D042883:Choledocholithiasis / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome