Laparoscopic minimal incision at cystic duct confluence for common bile duct stones in patients with thin-caliber...

To investigate the clinical utility of minimally invasive laparoscopic choledocholithotomy via the cystic duct confluence approach for secondary stones in slender common bile ducts. Data from 182 patients (74 male, 108 female; median age 45 years, range 32-68) with gallbladder calculus and secondary stones in slender common bile ducts (6-8 mm diameter), treated at Longhua District People's Hospital, Guangdong, China from September 2021 to June 2024, were retrospectively analyzed. Of these, 90 underwent laparoscopic choledocholithotomy via cystic duct confluence with primary sutures (minimally invasive group), while 92 underwent laparoscopic common bile duct exploration with T-tube drainage (T-tube group). Clinical data and perioperative indicators were compared between groups. In carefully selected patients with secondary stones in slender common bile ducts, the laparoscopic minimally invasive choledocholithotomy via the cystic duct confluence approach is a favorable option, enabling rapid recovery and meriting broader application. Clinical data for the 2 groups were comparable (P > .05). The minimally invasive group had a mean operative duration of 95.67 ± 25.56 minutes, intraoperative hemorrhage of 10.0 mL (5.0-10.0 mL), and Winslow's foramen drainage tube indwelling time of 4.47 ± 1.25 days. The stone clearance rate in the minimally invasive group was 100% (90 out of 90 patients). The T-tube group had an operative duration of 103.87 ± 29.83 minutes, intraoperative hemorrhage of 10.0 mL (5.0-10.0 mL), and Winslow's foramen drainage tube indwelling time of 3.76 ± 1.06 days. The stone clearance rate in the T-tube group was 100% (92 out of 92 patients). There were no statistical differences between the groups (P > .05). Compared with the T-tube group, the minimally invasive group experienced significantly shorter postoperative hospital stay (7.72 ± 1.63 vs 12 ± 2.45 days), lower treatment costs (1.75 ± 0.27 × 104 vs 2.16 ± 0.36 × 104 CNY), exhibited reduced postoperative numerical rating scale pain scores (1.56 ± 0.67 vs 4.13 ± 0.79), and earlier postoperative time to ambulation (8.34 ± 1.67 vs 15.56 ± 3.83 hours; P < .05). Both groups had comparable bile leakage rates (1.11% vs 1.08%; P > .05), with no cases of residual stones or biliary strictures.