Laparoscopic common bile duct exploration: choledochotomy versus transcystic approach?

Area of Science:

• Gastroenterology
• Minimally Invasive Surgery
• Surgical Innovation

Background:

• Choledocholithiasis, the presence of gallstones in the common bile duct (CBD), is a common condition requiring intervention.
• Laparoscopic common bile duct exploration (LCBDE) has become a standard treatment, with various approaches available.
• Comparing different LCBDE techniques is crucial for optimizing patient outcomes.

Purpose of the Study:

• To compare the outcomes of primary suture following 3-port laparoscopic common bile duct exploration (LCBDE) using a modified transcystic approach versus a transcholedochal approach.
• To evaluate the safety and efficacy of these two techniques in the management of choledocholithiasis.

Main Methods:

• A retrospective analysis was conducted on patients who underwent 3-port LCBDE.
• Eighty patients were treated with the modified transcystic approach, while 209 patients were treated with the transcholedochal approach.
• Key metrics analyzed included operative time, hospital stay duration, cystic duct and CBD diameters, and complication rates.

Main Results:

• Both the modified transcystic and transcholedochal LCBDE approaches were successfully performed without conversion to laparotomy or mortality.
• No significant differences were observed in operative time, hospital stay, cystic duct diameter, or complication rates between the two groups.
• A statistically significant difference was noted in the common bile duct diameter, with the transcholedochal group having a smaller CBD diameter.

Conclusions:

• The modified transcystic LCBDE is a safe and feasible option for treating choledocholithiasis.
• This technique may be particularly well-suited for patients with a smaller common bile duct diameter.
• Further research could explore patient selection criteria for each LCBDE approach.