Abstract: Objective The aim of this study was to compare the efficacy of endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic choledochotomy and exploration (LCE) in the treatment of patients with post-cholecystectomy choledocholithiasis. Methods Sixty patients with choledochal stones who had cholecystectomy were recruited in our hospital between February 2020 and February 2022, and we randomly assigned patients to receive LCE (observation, n=30) or ERCP (control, n=30). Serum C-peptide, cortisol (Cor), norepinephrine (Ne) and adrenocorticotrophic hormone (ACTH) levels were determined. Results The surgical successful rate and stone clearance rate in the observation group were 96.7% and 93.3%, both significantly higher than66.7% and 66.7% (P<0.05) in the control group; the operational time and medical cost in the observation group were (62.4±6.5)min and (20000.4±5000.0)yuan RMB, both much shorter or less than(106.3±8.7)min and (30000.0±8000.0)yuan RMB, P<0.05], while postoperative exhaustion time, ambulation time and hospital stay were much longer than in the control(P<0.05); five days after operation, serum Cor and Ne levels in the observation were (211.2±32.1)nmoL/mL and (5.0±0.6)nmoL/mL, significantly higher than [(152.1±41.2)nmoL/mL and (3.1±0.8)nmoL/mL, respectively, P<0.05] in the control; there were no significant differences in post-operational complications, such as bile leakage, infection, bleeding and pancreatitis between the two groups (20.0% vs. 16.7%, P>0.05). Conclusion The surgery by LCE in dealing with patients with choledocholithiasis who have gall bladder removed is promising, with high surgery success and stone clearance.

Key words: Choledocholithiasis, Laparoscopic choledochotomy and exploration, Endoscopic retrograde cholangiopancreatography, Therapy