Laparoscopic transcystic choledochotomy with primary suture for choledocholith

Area of Science:

• Minimally Invasive Surgery
• Gastrointestinal Surgery
• Surgical Innovation

Background:

• Gallbladder and common bile duct (CBD) stones pose significant clinical challenges.
• Traditional stone extraction methods can be invasive and carry risks.
• Developing safer, less invasive surgical options is crucial.

Purpose of the Study:

• To evaluate the feasibility and safety of laparoscopic transcystic choledochotomy for CBD stone extraction.
• To assess a novel technique involving choledochoscope insertion through the cystic duct.
• To determine the safety of primary double-layer suture for the cystic duct and CBD.

Main Methods:

• 194 patients with gallbladder and CBD stones underwent laparoscopic transcystic choledochotomy.
• A choledochoscope was inserted via the cystic duct into the CBD for stone removal.
• Primary double-layer suture (mucous layer and seromuscular Lembert suture) was used for closure.

Main Results:

• All 194 procedures were successfully completed with no intraoperative complications.
• Postoperative Magnetic Resonance Cholangiopancreatography (MRCP) showed no abnormal CBD diameter changes in 55 patients.
• 90% of patients (176) showed no recurrence or CBD stricture during 1-30 months follow-up; minor complications included bile leakage (2 patients) and transient pain/jaundice (1 patient).

Conclusions:

• Laparoscopic transcystic choledochotomy with primary suture is a feasible and safe approach for CBD stone extraction.
• This technique offers a minimally invasive alternative for managing gallbladder and CBD stones.
• The double-layer primary suture technique ensures secure closure and good long-term outcomes.