To evaluate the safety and efficacy of laparoscopic common bile duct exploration (LCBDE) combined with choledochoscopy and antegrade indwelling of nasobiliary catheter with duodenoscopy, and primary suture of common bile duct.

200 patients with common bile duct stones admitted to the Third Affiliated Hospital of Naval Medical University and Xuancheng People’s Hospital from January 2020 to January 2022 were enrolled in this study. Among them, 73 patients were male and 127 female, aged from 17 to 93 years, with a median age of 64 years. All patients were randomly divided into triple-endoscopy (n=100) and double-endoscopy groups (n=100). In the triple-endoscopy group, LCBDE combined with choledochoscopy and antegrade indwelling nasobiliary catheter with duodenoscope, and primary suture of common bile duct was adopted. In the double-endoscopy group, LCBDE with choledochoscopic lithotomy and primary suture of common bile duct was employed. The operation time and intraoperative blood loss between two groups were compared by t test and rank-sum test. The incidence of complications between two groups was compared by Chi-square test. The safety and efficacy of triple-endoscopy combined surgery were evaluated.

No significant differences were observed in intraoperative blood loss, conversion rate to open surgery, removal time of postoperative abdominal drainage tube and the length of postoperative hospital stay between two groups (all P>0.05). The operation time in the triple-endoscopy group was (92±18) min, significantly longer than (79±17) min in the double-endoscopy group (t=5.339, P<0.001). The incidence of postoperative bile leakage in the triple-endoscopy group was 1%(1/100), significantly lower than 7%(7/100) in the double-endoscopy group (χ²=4.688, P=0.030). All patients with bile leakage were recovered at 1-2 weeks after drainage. No intraoperative pancreatitis was observed in two groups. In the triple-endoscopy group, 1 patient developed recurrence of common bile duct stones and 1 case of common bile duct stenosis, and 3 and 1 in the double-endoscopy group, with no statistical significance between two groups (χ²=1.192, P=0.275).

LCBDE combined with choledochoscopy lithotomy and antegrade indwelling nasobiliary catheter and primary suture of common bile duct can accelerate postoperative rehabilitation, shorten the length of postoperative hospital stay and reduce the incidence of bile leakage.