Laparoscopic Common Bile Duct Exploration: Choledochotomy Versus Transcystic Approach?

Purpose:To compare the difference of primary suture following 3-port laparoscopic common bile duct exploration (LCBDE) between modified transcystic and transcholedochal approach in the treatment of choledocholithiasis.Materials and Methods:Patients who underwent 3-port LCBDE by modified transcystic approach (n=80) and those who underwent 3-port LCBDE by transcholedochal approach (n=209) were included in this study. The operative time, duration of hospital stay, diameter of the cystic duct, diameter of the common bile duct (CBD), complications, and demographics were retrospectively analyzed in all patients.Results:All operations were successfully performed. No patient was converted to laparotomy. No mortality was associated with the 2 groups. There was no significant difference between the 2 groups for the operative time (91.9434.21 min vs. 96.13 +/- 32.15 min), duration of hospital stay (9.82 +/- 3.48 d vs. 10.74 +/- 5.34 d), diameter of cystic duct (0.47 +/- 0.09 cm vs. 0.47 +/- 0.08 cm), and complications (2.5% vs. 2.87%) (all P>0.05). A significant difference was observed in terms of the diameter of CBD (1.18 +/- 0.29 cm vs. 1.04 +/- 0.24 cm P<0.05).Conclusions:The modified transcystic LCBDE was safe and feasible for treating choledocholithiasis but it might be more suitable for the CBD with a smaller diameter.