Microincision of the Cyst Duct Is Safe and Effective for the Failed Laparoscopic Transcystic Common Bile Duct Exploration

To explore whether transcystic-laparoscopic common bile duct exploration with microincision of the cystic duct and its confluence partis effective and safe as transductal-laparoscopic common bile duct exploration for the failed transcystic-laparoscopic common bile duct exploration in patients with choledocholithiasis. In this retrospective cohort study, we assigned patients with cholecystocholedocholithiasis to undergo transcystic-laparoscopic common bile duct exploration and laparoscopic cholecystectomy. The clinical outcomes of one-to-one propensity-matched pairs of transcystic-laparoscopic common bile duct exploration with microincision and transductal-laparoscopic common bile duct exploration groups were compared. Of 1650 patients with confirmed choledocholithiasis attempted transcystic-laparoscopic common bile duct exploration, transcystic-laparoscopic common bile duct exploration with microincision was done successfully in 128 patients (7.8%) and transductal-laparoscopic common bile duct exploration 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 transcystic-laparoscopic common bile duct exploration with the microincision group and 11.8% in the transductal-laparoscopic common bile duct exploration group (P = 0.573). The duration of operation in transcystic-laparoscopic common bile duct exploration with microincision was a little shorter than that in transductal-laparoscopic common bile duct exploration: median 125 (interquartile range 95-173) versus 150 (120-195) min, respectively (P = 0.003). Postoperative recovery was faster in transcystic-laparoscopic common bile duct exploration with microincision than in transductal-laparoscopic common bile duct exploration, 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 common bile duct stone between the groups. Transcystic-laparoscopic common bile duct exploration with microincision is as effective and safe as transductal-laparoscopic common bile duct exploration in patients with failed transcystic-laparoscopic common bile duct exploration.