Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Mar 27, 2024; 16(3): 759-767
Published online Mar 27, 2024. doi: 10.4240/wjgs.v16.i3.759
Comparison of the clinical effects of dual-modality endoscopy and traditional laparotomy for the treatment of intra- and extrahepatic bile duct stones
Wei Wang, Hui Xia, Bin Dai
Wei Wang, Hui Xia, Bin Dai, Department of Hepatobiliary Surgery, Wuhan No.1 Hospital, Wuhan 430030, Hubei Province, China
Co-first authors: Wei Wang and Hui Xia.
Author contributions: Wang W and Xia H contributed equally to this work and are co-first authors; Wang W and Xia H designed the research and wrote the first manuscript; Wang W, Xia H and Dai B contributed to conceiving the research and analyzing data; Wang W and Xia H conducted the analysis and provided guidance for the research; all authors reviewed and approved the final manuscript.
Supported by 2021 Municipal Health Commission Scientific Research Project, No. WX21D48; 2021 Municipal Health Commission Project, No. WZ21Q11; and 2022 Hubei Provincial Department of Science and Technology Project, No. 2022CFB980.
Institutional review board statement: This study was approved by the Ethic Committee of Wuhan No.1 Hospital.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: There is no conflict of interest.
Data sharing statement: All data and materials are available from the corresponding author.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bin Dai, PhD, Doctor, Department of Hepatobiliary Surgery, Wuhan No.1 Hospital, No. 215 ZhongShan Street, Wuhan 430030, Hubei Province, China. drdbmd@163.com
Received: December 12, 2023
Peer-review started: December 12, 2023
First decision: January 2, 2024
Revised: January 15, 2024
Accepted: February 28, 2024
Article in press: February 28, 2024
Published online: March 27, 2024
Processing time: 101 Days and 2.6 Hours
Abstract
BACKGROUND

Bile duct stones (BDSs) may cause patients to develop liver cirrhosis or even liver cancer. Currently, the success rate of surgical treatment for intrahepatic and extrahepatic BDSs is not satisfactory, and there is a risk of postoperative complications.

AIM

To compare the clinical effects of dual-modality endoscopy (duodenoscopy and laparoscopy) with those of traditional laparotomy in the treatment of intra- and extrahepatic BDSs.

METHODS

Ninety-five patients with intra- and extrahepatic BDSs who sought medical services at Wuhan No.1 Hospital between August 2019 and May 2023 were selected; 45 patients in the control group were treated by traditional laparotomy, and 50 patients in the research group were treated by dual-modality endoscopy. The following factors were collected for analysis: curative effects, safety (incision infection, biliary fistula, lung infection, hemobilia), surgical factors [surgery time, intraoperative blood loss (IBL) volume, gastrointestinal function recovery time, and length of hospital stay], serum inflammatory markers [tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-8], and oxidative stress [glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), malondialdehyde (MDA), and advanced protein oxidation products (AOPPs)].

RESULTS

The analysis revealed markedly better efficacy (an obviously higher total effective rate) in the research group than in the control group. In addition, an evidently lower postoperative complication rate, shorter surgical duration, gastrointestinal function recovery time and hospital stay, and lower IBL volume were observed in the research group. Furthermore, the posttreatment serum inflammatory marker (TNF-α, IL-6, and IL-8) levels were significantly lower in the research group than in the control group. Compared with those in the control group, the posttreatment GSH-Px, SOD, MDA and AOPPs in the research group were equivalent to the pretreatment levels; for example, the GSH-Px and SOD levels were significantly higher, while the MDA and AOPP levels were lower.

CONCLUSION

Dual-modality endoscopy therapy (duodenoscopy and laparoscopy) is more effective than traditional laparotomy in the treatment of intra- and extrahepatic BDSs and has a lower risk of postoperative complications; significantly shortened surgical time; shorter gastrointestinal function recovery time; shorter hospital stay; and lower intraoperative bleeding volume, while having a significant inhibitory effect on excessive serum inflammation and causing little postoperative oxidative stress.

Keywords: Dual-modality endoscopy; Traditional laparotomy; Intra- and extrahepatic bile duct stones; Clinical efficacy

Core Tip: This study compared the clinical effects of dual-modality endoscopy (duodenoscopy and laparoscopy) vs traditional laparotomy in the treatment of intra- and extra-hepatic bile duct stones, and confirmed that the dual-modality endoscopy has significantly superior clinical advantages over the other from the perspectives of efficacy, safety, surgical indicators, serum inflammation, oxidative stress, etc.