Clinical effect analysis of three-port laparoscopic and choledochoscopic common bile duct exploration without T-tube in the treatment of emergency cholecystolithiasis combined with common bile duct stones

Objective To investigate the clinical application value of three-port laparoscopy combined with choledochoscopic common bile duct exploration without T tube in the treatment of emergency patients with choledocholithiasis. Methods From December 2023 to July 2024, the clinical data of 103 patients with emergency cholecystolithiasis complicated with common bile duct stones in the Department of General Surgery, Beijing Fengtai Youanmen Hospital were collected. Among them, 44 patients underwent three-port laparoscopy combined with choledochoscopy for common bile duct exploration without T-tube operation, and 59 patients underwent four-port laparoscopy combined with choledochoscopy for common bile duct exploration with T-tube drainage. The preoperative, intraoperative and postoperative indexes of the two groups were compared. Results There was no significant difference in preoperative general data between the two groups (all P > 0.05). Three-port laparoscopic T-tube-free method was better than four-port laparoscopic T-tube method in postoperative pain, removal of abdominal drainage tube and length of hospital stay (all P <0.05). There was 1 case of pancreatitis in each group. There was no conversion to open surgery, no residual stones, no hemobilia and no biliary stricture in both groups. There was 1 case of bile leakage after four-hole T-tube placement and 1 case of bile leakage after T-tube removal. Conclusion Three-hole laparoscopy combined with choledochoscopy for common bile duct exploration without T-tube in emergency patients is safe and feasible. Compared with T-tube group, T-tube-free method is more consistent with the concept of rapid recovery.