Laparoscopic Transcystic Ultra-fine Choledochoscopy for Cholecystolithiasis with Small-diameter Choledocholithiasis

This study aimed to assess the feasibility and safety of laparoscopy combined with ultra-fine choledochoscopy for treating cholecystolithiasis with Small-diameter choledocholithiasis (common bile duct ≤ 0.8 cm). Fifty-eight patients diagnosed from June 2020 to December 2022 were retrospectively analyzed. To validate the protocol, we retrospectively analyzed two groups of patients managed with either T-tube placement (n = 30) or primary suture (n = 28) following stone extraction. The T-tube group underwent laparoscopic cholecystectomy with transcystic stone extraction and T-tube drainage, while the primary suture group underwent the same procedure with primary closure. Baseline data (total bilirubin, AST, GGT, ALT, comorbidities, albumin, age, gender, BMI, alcohol use, smoking) and perioperative outcomes were recorded. Follow-ups of at least 12 months were conducted to monitor postoperative complications. The retrospective validation showed no significant differences in baseline characteristics between the two groups (P> 0.05). No significant differences were observed between groups in operative time, blood loss, stone size/number, infection, bile leakage, or hospital stay (P> 0.05). The overall complication rate was 10% (6/58), and no deaths occurred. Follow-up ranged from 12 to 40 months (median 24 months). During the follow-up period, which relied on clinical and biochemical monitoring, no symptomatic biliary strictures or stone recurrences were identified. These findings suggest that laparoscopic transcystic ultra-fine choledochoscopy is a safe, feasible, and effective approach for managing cholecystolithiasis with Small-Diameter choledocholithiasis, offering satisfactory perioperative outcomes and long-term safety.