Laparoscopic Transcystic Ultra-fine Choledochoscopy for Cholecystolithiasis with Small-diameter Choledocholithiasis

Summary

This study evaluates the use of laparoscopic transcystic ultra-fine choledochoscopy for treating cholecystolithiasis with Small-diameter choledocholithiasis. The results show that this method is feasible, safe, and effective, with no significant differences in perioperative outcomes or long-term complications between patients with primary suture and those with T-tube placement.

Abstract

This study aimed to assess the feasibility and safety of laparoscopy combined with ultra-fine choledochoscopy for treating cholecystolithiasis with Small-diameter choledocholithiasis (common bile duct ≤ 0.8 cm). Fifty-eight patients diagnosed from June 2020 to December 2022 were retrospectively analyzed. To validate the protocol, we retrospectively analyzed two groups of patients managed with either T-tube placement (n = 30) or primary suture (n = 28) following stone extraction. The T-tube group underwent laparoscopic cholecystectomy with transcystic stone extraction and T-tube drainage, while the primary suture group underwent the same procedure with primary closure. Baseline data (total bilirubin, AST, GGT, ALT, comorbidities, albumin, age, gender, BMI, alcohol use, smoking) and perioperative outcomes were recorded. Follow-ups of at least 12 months were conducted to monitor postoperative complications. The retrospective validation showed no significant differences in baseline characteristics between the two groups (P > 0.05). No significant differences were observed between groups in operative time, blood loss, stone size/number, infection, bile leakage, or hospital stay (P > 0.05). The overall complication rate was 10% (6/58), and no deaths occurred. Follow-up ranged from 12 to 40 months (median 24 months). During the follow-up period, which relied on clinical and biochemical monitoring, no symptomatic biliary strictures or stone recurrences were identified. These findings suggest that laparoscopic transcystic ultra-fine choledochoscopy is a safe, feasible, and effective approach for managing cholecystolithiasis with Small-Diameter choledocholithiasis, offering satisfactory perioperative outcomes and long-term safety.

Introduction

Cholecystolithiasis is a highly prevalent condition worldwide, and approximately 10-20% of these patients present with concomitant choledocholithiasis¹. Stones within the common bile duct can cause biliary obstruction, leading to clinical symptoms such as abdominal pain, jaundice, and fever. If left untreated, it may progress to severe complications, including acute cholangitis, pancreatitis, and even sepsis, posing a significant threat to patient health^2,3.

The surgical management of choledocholithiasis has evolved considerably. Traditional open common bile ....

Protocol

The protocol was conducted in accordance with the Declaration of Helsinki, and it was approved by the Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University Ethics Committee. The following steps detail the laparoscopic transcystic ultra-fine choledochoscopy for the management of cholecystolithiasis with small-diameter choledocholithiasis (common bile duct diameter ≤ 0.8 cm).

NOTE: We retrospectively analyzed 58 patients with cholecystolithiasis and Small-Diameter choledocholithiasis (common bile duct diameter ≤ 0.8 cm) hospitalized at the Hepatopancreatobiliary Surgery Department of Xuzhou First People's Hospital ....

Results

A total of 58 patients underwent the laparoscopic transcystic ultra-fine choledochoscopy procedure. The baseline characteristics showed no statistically significant differences (all P>0.05) (see Table 1).

The procedural success rate for transcystic scope insertion on the first attempt was 87.9% (51/58). In 7 cases, the cystic duct required dilation or a minimal extension of the incision to allow choledochoscope passage. There were 2 (3.4%) conversions to formal laparoscopic.......

Discussion

Approximately one-fifth of patients with cholecystolithiasis also suffer from choledocholithiasis. Stones can cause biliary obstruction, resulting in such symptoms as abdominal pain or jaundice among patients who will experience acute cholangitis, pancreatitis, or even death in severe cases^12,13. For patients with cholecystolithiasis in combination with choledocholithiasis, the traditional method of open common bile duct exploration is commonly used for stone ret.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
electronic endoscope	Zhuhai Pusen Medical Technology Co., Ltd.	PU3022A	The electronic endoscope (with an outer diameter of 0.35cm) is used to be inserted into common bile ducts through cystic ducts for stone retrieval during the surgical procedure.
fluorescence laparoscopy	Stryker	1688 4K	The 1688 4K fluorescence laparoscopy is used to assist in observing the surgical field during the operation under general anesthesia.
holmium laser lithotripsy system	Henan Forever Medical Co., Ltd.	DHL-1	The holmium laser lithotripsy system is used to fragment relatively large stones into fine or sandy particles for subsequent retrieval during stone extraction in the surgical procedure.