COMPARATIVE ANALYSIS OF FOUR SURGICAL TECHNIQUES FOR CHOLEDOCHOLITHIASIS MANAGEMENT IN ATHLETES: A COHORT STUDY

Abstract

Objective: To assess the effectiveness and safety of four distinct surgical techniques for managing common bile duct (CBD) in athletes with choledocholithiasis. Methods: This cohort study involved 160 athletes diagnosed with choledocholithiasis who underwent one of four surgical treatments: laparoscopic common bile duct exploration with primary duct closure (LCBDE+PDC), T-tube drainage (LCBDE+TTD), C-tube drainage (LCBDE+PDC+CTD), or endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy, endoscopic papillary balloon dilatation, and endoscopic nasobiliary drainage (ERCP+EST+ENBD). Data on patient demographics (age, gender, BMI, ASA score), CBD diameter, concomitant symptoms, surgical outcomes, and complications were collected and analyzed. Results: Athletes undergoing LCBDE+PDC, LCBDE+PDC+CTD, and ERCP+EST+ENBD experienced shorter postoperative hospital stays compared to those receiving LCBDE+TTD. Procedures involving PDC and CTD were quicker than T-tube placement. Moreover, the removal time for nasobiliary ducts and C-tubes was less than that for T-tubes. Athletes treated with ERCP+EST+ENBD reported higher incidences of upper digestive tract discomfort, postoperative pancreatitis, and need for subsequent operations, whereas those undergoing LCBDE+TTD had higher rates of skin/soft tissue infections. Conclusions: All four surgical methods—LCBDE+PDC, LCBDE+TTD, LCBDE+PDC+CTD, and ERCP+EST+ENBD—are effective for treating choledocholithiasis in athletes. However, PDC and CTD approaches offer quicker procedures and potentially shorter recovery times compared to traditional T-tube drainage, making them promising options for managing CBD in this specific population. These findings suggest that tailored surgical approaches can enhance recovery and reduce hospital stay for athletes undergoing treatment for choledocholithiasis