To evaluate the safety and efficacy of percutaneous transhepatic cholangioscopy (PTCS) in the treatment of choledocholithiasis complicated with acute cholangitis.

Clinical data of 95 patients with choledocholithiasis complicated with acute cholangitis undergoing selective operation after PTCD in Central People's Hospital of Zhanjiang from November 2012 to November 2017 were retrospectively analyzed. Among them, 44 patients were male and 51 female, aged (55±9) years on average. The informed consents of all patients were obtained and the local ethical committee approval was received. All patients underwent emergent PTCD and received secondary operation after infection control. Patients were divided into the PTCS group (n=43) and laparoscopic common bile duct exploration group (LCBDE group, n=52) according to different surgical methods. In the PTCS group, patients received laparoscopic cholecystectomy (LC) + PTCS lithotomy, whereas those in the LCBDE group received LC + LCBDE + T-tube drainage. The operation time and postoperative removal time of biliary drainage tube were statistically compared between two groups by t test. The incidence of postoperative complications was compared by Chi-square test.

All patients completed the operation successfully without conversion to open surgery. In the PTCS group, the operation time and postoperative removal time of biliary drainage tube were (90±16) min and (8.0±1.4) d, significantly shorter than (184±18) min, (31.3±1.8) din the LCBDE group (t=-26.620, -70.555; P<0.05). No perioperative death or serious complications occurred in two groups. In the PTCS group, 2 cases suffered from biliary hemorrhage and 1 case of right pleural effusion. In the LCBDE group, 3 cases suffered from biliary leakage. No significant difference was observed in the incidence of postoperative complications between two groups (χ2=0.058, P>0.05). The stone removal rate was 100% in both groups. The follow-up time was 12-36 months with a median of 26. No recurrence of stones or cholangitis was found during the postoperative follow-up.

PTCS is a safe and efficacious surgical treatment for choledocholithiasis complicated with acute cholangitis, which causes mild trauma and accelerates postoperative recovery.