Microincision of the cyst duct is safe and effective for the failed laparoscopic transcystic common bile duct exploration

Abstract

Microincision of the cystic duct and its confluence part, which facilitated the application of transcystic-laparoscopic common bile duct (CBD) exploration (transcystic-LCBDE), had been described in some reports. However, it is unclear whether transcystic-LCBDE with microincision (micro-LCBDE) is effective and safe as transductal-LCBDE for the failed transcystic-LCBDE in patients with choledocholithiasis. In this retrospective cohort study, we assigned patients with cholecystocholedocholithiasis to undergo transcystic-LCBDE and laparoscopic cholecystectomy. The clinical outcomes of one-to-one propensity-matched pairs of Micro-LCBDE and transductal-LCBDE groups were compared. Between January 2007 and December 2018, 1650 patients with confirmed choledocholithiasis attempted transcystic-LCBDE. Micro-LCBDE was done successfully in 128 patients (7.8%) and transductal-LCBDE in 69 patients (4.2%). By one-to-one propensity score matching, 68 pairs were selected. There was no significant difference in in-hospital complication rate: 8.8% in micro-LCBDE group and 11.8% in transductal-LCBDE group (p = 0.573). The duration of operation in micro-LCBDE was a little shorter than that in transductal-LCBDE: median 125 (interquartile range 95-173) versus 150 (120-195) min respectively (p = 0.003). Postoperative recovery was faster in micro-LCBDE than in transductal-LCBDE, as reflected by a shorter postoperative hospital stay (median 3 versus 5 days, p = 0.002, respectively). There was also no significant difference in rates of retained stone and recurrence of CBD stone between the groups. Our findings suggest that micro-LCBDE surgery was effective and safe as transductal-LCBDE surgery in patients with failed transcystic-LCBDE, suggesting that the micro-LCBDE is an acceptable alternative to transductal-LCBDE for failed transcystic-LCBDE.