Three modalities on common bile duct exploration

Area of Science:

• Gastroenterology and Hepatobiliary Surgery

Background:

• Choledocholithiasis management involves transcystic (TC), transduct (TD), and left hepatic duct (LHD) stone extraction.
• Cholangioscopy is utilized for common bile duct (CBD) stone removal.
• The study focuses on comparing TC and LHD approaches against the TD approach.

Purpose of the Study:

• To evaluate the safety and effectiveness of TC, TD, and LHD approaches for choledocholithiasis.
• To specifically compare TC and LHD approaches against the TD approach.

Main Methods:

• A total of 172 patients with choledocholithiasis and cholecystitis or left intrahepatic gallstones underwent laparoscopic or open CBD exploration.
• Patients were divided into TD (n=72), TC (n=63), and LHD (n=37) groups.
• Primary outcomes included operative time, hospital stay, and postoperative bile leaks.

Main Results:

• Successful bile duct clearance rates were 100% (TD), 93.6% (TC), and 90.9% (LHD).
• The TD group had a higher incidence of bile leaks (12.5%) and T-tube placement (16 cases) compared to TC (3.2% bile leaks, 0% T-tube) and LHD (0% bile leaks, 0% T-tube).
• The LHD group showed a significantly shorter operative time for patients with left intrahepatic gallstones compared to the TD group (121.1 vs. 149.3 minutes).

Conclusions:

• The TD approach achieved higher stone clearance but carried a greater risk of bile leaks and T-tube use.
• TC and LHD stone extraction demonstrated lower complication rates, suggesting greater effectiveness.
• TC and LHD approaches are accessible techniques that simplify procedures by avoiding choledochotomy and T-tube insertion.