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Transductal versus transcystic laparoscopic common bile duct exploration: an institutional review of over four hundred cases

  • 2019 EAES Oral
  • Published:
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Abstract

Background

Many studies have failed to demonstrate significant differences between single- and two-staged approaches for the management of choledocholithiasis with concomitant gallstones in terms of post-operative morbidity. However, none of these studies paid specific attention to the differences between the methods of accessing the bile duct during laparoscopy. The aim of this study was to report outcomes of transcystic versus transductal laparoscopic common bile duct exploration (LCBDE) from our experience of over four hundred cases.

Methods

Retrospective review of 416 consecutive patients who underwent LCBDE at a single-centre between 1998 and 2018 was performed. Data collected included pre-operative demographic information, medical co-morbidity, pre-operative investigations, intra-operative findings (including negative choledochoscopy rates, use of holmium laser lithotripsy and operative time) and post-operative outcomes.

Results

Transductal LCBDE via choledochotomy was achieved in 242 patients (58.2%), whereas 174 patients (41.8%) underwent transcystic LCBDE. Stone clearance rates, conversion to open surgery and mortality were similar between the two groups. Overall morbidity as well as minor and major post-operative complications were significantly higher in the transductal group. The main surgery-related complications were bile leak (5.8% vs 1.1%, p = 0.0181) and pancreatitis (7.4% vs 0.6%, p = 0.0005). Median length of post-operative stay was also significantly greater in the transductal group.

Conclusion

This study represents the largest single study to date comparing outcomes from transcystic and transductal LCBDE. Where possibly, the transcystic route should be used for LCBDE and this approach can be augmented with various techniques to increase successful stone clearance and reduce the need for choledochotomy.

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Funding

There was no funding for this study.

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Authors and Affiliations

  1. Department of Upper GI Surgery, Northwick Park Hospital & St Mark′s Hospital, Watford Road, London, HA1 3UJ, UK

    Lalin Navaratne & Alberto Martinez Isla

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  1. Lalin Navaratne
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  2. Alberto Martinez Isla
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Contributions

Study conception and design: LN/AI. Acquisition of data: AI. Analysis and interpretation of data: LN. Drafting of manuscript: LN/AI. Critical revision of manuscript: LN/AI.

Corresponding author

Correspondence to Lalin Navaratne.

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Conflict of interest

Lalin Navaratne and Alberto Martinez Isla have no conflict of interest to declare or financial ties to disclose.

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Navaratne, L., Martinez Isla, A. Transductal versus transcystic laparoscopic common bile duct exploration: an institutional review of over four hundred cases. Surg Endosc 35, 437–448 (2021). https://doi.org/10.1007/s00464-020-07522-7

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