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Transcystic papillary balloon dilatation vs. laparoscopic choledochoscopy for choledocholithiasis: a retrospective
Dmitrijs Aleksandrovs1,2, Haralds Plaudis3,4, Vladimirs Fokins3,4
1Department of Emergency and General Surgery, Riga East Clinical University Hospital "Gaiļezers", 2 Hipokrata St., Riga, LV-1079, Latvia. Dmitrijs.aleksandrovs@aslimnica.lv.
Insights
Transcystic papillary balloon dilatation (TCPBD) and laparoscopic choledochoscopy (LCC) show similar success rates for common bile duct stone removal during gallbladder surgery. Individualized technique selection is recommended based on patient and stone factors.
Area of Science:
- Gastroenterology
- Minimally Invasive Surgery
- Biliary Tract Surgery
Background:
- Choledocholithiasis management during laparoscopic cholecystectomy involves techniques like transcystic papillary balloon dilatation (TCPBD) and laparoscopic choledochoscopy (LCC).
- Comparative data on the efficacy of these intraoperative clearance methods are limited.
Purpose of the Study:
- To compare the procedural success and complication rates of TCPBD versus LCC for single-stage management of choledocholithiasis.
- To identify factors influencing the choice between TCPBD and LCC.
Main Methods:
- Retrospective, single-center observational cohort study of 132 patients undergoing one-stage treatment for choledocholithiasis.
- 93 patients underwent TCPBD, and 39 underwent LCC.
- Propensity score matching was used to control for patient characteristics and stone burden.
Main Results:
- Procedural success rates were comparable: 95.7% for TCPBD and 92.3% for LCC (p=0.421).
- Overall complication rates were similar (9.7% vs. 7.7%, p=1.000), with no significant difference in postoperative pancreatitis.
- TCPBD was associated with a longer hospital stay in unmatched analyses, but this difference was attenuated after matching.
Conclusions:
- No statistically significant differences in duct-clearance success or morbidity were observed between TCPBD and LCC.
- Technique selection should be individualized based on patient factors, biliary anatomy, stone characteristics, and surgeon expertise.
- Further prospective comparative studies are warranted to confirm these findings.
Background:
Single-stage management of choledocholithiasis during laparoscopic cholecystectomy can be performed using transcystic papillary balloon dilatation (TCPBD) or laparoscopic choledochoscopy (LCC). Direct comparative data between intraoperative clearance techniques remain limited.
Methods:
We conducted a retrospective single-center observational cohort study of 132 consecutive adult patients undergoing documented one-stage minimally invasive treatment for choledocholithiasis between January 2020 and January 2026. Ninety-three patients underwent TCPBD and 39 underwent LCC. The primary endpoint was procedural success, defined as complete duct clearance during the index procedure without conversion, biliary drainage, retained stones requiring postoperative ERCP, or other additional duct-clearance procedures. Secondary endpoints included overall and major complications, postoperative pancreatitis, reoperation, conversion, operative time, and hospital length of stay. Propensity score matching was performed using age, body mass index, stone diameter, and acute calculous cholecystitis.
Results:
Procedural success was achieved in 89/93 TCPBD patients (95.7%) and 36/39 LCC patients (92.3%) (OR 1.85, 95% CI 0.40-8.70; RD 3.4, 95% CI - 4.6 to 16.3; p = 0.421). Overall complications occurred in 9.7% versus 7.7% (OR 1.29, 95% CI 0.33-5.03; RD 2.0, 95% CI - 11.4 to 11.2; p = 1.000). Mild postoperative pancreatitis occurred in 4.3% versus 5.1% of patients. TCPBD patients were older, had higher body mass index, larger stones, and more frequent acute calculous cholecystitis. Postoperative length of stay was longer after TCPBD in the unmatched and adjusted analyses (IRR 1.47, 95% CI 1.08-2.00; p = 0.014), but this difference was attenuated after propensity score matching. Wide confidence intervals limit inference for uncommon outcomes.
Conclusions:
In this retrospective non-randomized cohort, no statistically significant differences in duct-clearance success or morbidity were detected between TCPBD and LCC. Technique selection should remain individualized according to patient factors, biliary anatomy, stone characteristics, and available expertise. Prospective comparative studies are warranted.