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Laparoscopic Common Bile Duct Exploration Followed by Primary Suture Using a Modified Bile Duct Incision
Published on: May 2, 2025
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Laparoscopic Transcystic Versus Transductal Common Bile Duct Exploration: A Systematic Review and Meta-analysis
Shahin Hajibandeh1, Shahab Hajibandeh2, Diwakar Ryali Sarma3
1Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK. shahin_hajibandeh@yahoo.com.
World Journal of Surgery
|April 18, 2019
Summary
Laparoscopic transcystic (TC) common bile duct (CBD) exploration is safer and leads to fewer complications than the transductal (TD) approach. TC also reduces hospital stay and procedure time, offering a better patient outcome.
Area of Science:
- Minimally Invasive Surgery
- Gastrointestinal Surgery
- Surgical Outcomes Research
Background:
- Laparoscopic common bile duct (CBD) exploration is a key procedure for managing choledocholithiasis.
- Transcystic (TC) and transductal (TD) approaches are two primary laparoscopic methods for CBD exploration.
- Comparative effectiveness data between TC and TD approaches are crucial for surgical decision-making.
Purpose of the Study:
- To systematically evaluate and compare the outcomes of laparoscopic transcystic (TC) versus transductal (TD) common bile duct (CBD) exploration.
- To determine which laparoscopic approach offers superior results in terms of efficacy and safety.
Main Methods:
- Systematic literature search across multiple databases (MEDLINE, EMBASE, CINAHL, CENTRAL, clinical trial registries).
- Inclusion of 30 studies involving 4073 patients comparing laparoscopic TC (n=2176) and TD (N=1897) CBD exploration.
- Primary outcomes: CBD clearance rate, perioperative and biliary complications. Secondary outcomes: procedure time, hospital stay, conversion to open procedure. Random-effects models were used for meta-analysis.
Main Results:
- The TC approach showed significantly lower overall complications (RD: -0.07, P=0.001) and biliary complications (RD: -0.05, P=0.0003) compared to TD.
- TC also resulted in significantly less blood loss (MD: -16.20, P=0.02), shorter hospital stay (MD: -2.62, P<0.00001), and reduced procedure time (MD: -12.73, P=0.005).
- No significant differences were observed in CBD clearance rates (RD: 0.00, P=0.77) or conversion to open procedure rates (RD: 0.00, P=0.86).
Conclusions:
- Laparoscopic TC CBD exploration is a safe and effective method, demonstrating reduced overall morbidity and biliary complications compared to the TD approach.
- The TC approach offers significant advantages in terms of shorter hospital stays and procedure times.
- Further high-quality randomized trials are recommended to explore the impact of specific patient and anatomical factors on comparative outcomes.
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