Laparoscopic Cystic Duct Balloon Dilation Combined with Transcystic Stone Extraction for the Treatment of Choledocholithiasis

Summary

This protocol standardizes the surgical workflow for laparoscopic cystic duct balloon dilation combined with laparoscopic transcystic common bile duct exploration (LTCBDE). Its core objective is to overcome the anatomical constraints of the cystic duct via balloon dilation, thereby facilitating safe, minimally invasive clearance of choledocholithiasis.

Abstract

Common bile duct stones (CBDS) are a common benign disorder of the digestive system. Severe cases can be complicated by acute cholangitis or biliary pancreatitis, posing a potentially life-threatening risk to patients. Currently, the primary minimally invasive therapeutic modalities include endoscopic retrograde cholangiopancreatography (ERCP), laparoscopic choledochotomy for common bile duct exploration (LCCBDE), and laparoscopic transcystic common bile duct exploration (LTCBDE). However, ERCP requires incision of the duodenal papilla, which may irreversibly impair the sphincter of Oddi and increase the risk of retrograde biliary infections. Conversely, LCCBDE traditionally requires choledochotomy and T-tube placement, which not only elevates the risks of bile leakage and biliary stricture but also compromises the patient's quality of life. Although LTCBDE preserves the physiological integrity of the biliary tract, the conventional procedure is often technically demanding due to anatomical variations, such as a narrow cystic duct. To overcome this technical bottleneck, this study introduced laparoscopic cystic duct balloon dilation combined with LTCBDE to mechanically expand the narrow cystic duct. The authors retrospectively reviewed the clinical data of patients who underwent these three surgical modalities at the institution between 2018 and 2024. The results demonstrated that balloon dilation combined with the LTCBDE group showed favorable outcomes, including a shorter hospital stay, lower total hospitalization costs, and a low incidence of postoperative complications. These findings indicate that this modified approach appears to be a safe, effective, and cost-effective alternative strategy for the management of low-to-moderate complexity choledocholithiasis.

Introduction

Common bile duct stones (CBDS) are among the most prevalent benign disorders of the digestive system. In the general population, the prevalence of cholelithiasis ranges from 10–15%¹, and approximately 10–20% of patients with a history of gallstones have concomitant CBDS². The incidence of CBDS increases with age, rendering it particularly prevalent among the elderly³. The pathogenesis of CBDS is multifactorial, involving abnormal bile composition, biliary obstruction, and biliary infection⁴. Although some patients remain asymptomatic, typical symptomatic manifes....

Protocol

The relevant surgeries were approved by the Institutional Review Board (Ethics Committee) of the Second Affiliated Hospital of Soochow University (No. JD-HG-2025-084). All included patients provided written informed consent prior to undergoing the surgical procedures. The primary surgical consumables required for the procedure are listed in the Table of Materials.

1. Inclusion criteria

1. Include patients age ≥ 18 years, diagnosed with gallbladder stones combined with common bile duct stones via abdominal Doppler ultrasound, CT, or magnetic resonance cholangiopancreatography (MRCP); stone dia....

Results

To illustrate the representative clinical performance of this modified method, clinical data from patients who underwent surgery for CBDS at the Second Affiliated Hospital of Soochow University between January 2018 and December 2024 were retrospectively collected. The detailed patient selection process is illustrated in the flowchart (Figure 6). A total of 310 patients were included in the study: 40 patients underwent balloon dilation combined with LTCBDE, 70 received ERCP alone (without con.......

Discussion

With the evolution of minimally invasive techniques, the management of CBDS has transitioned from traditional open surgery to comprehensive therapeutic modalities predominantly involving endoscopic and laparoscopic approaches⁶. Currently, the most widely utilized clinical strategies include ERCP, LCCBDE, and LTCBDE⁷. However, ERCP requires an endoscopic sphincterotomy (incision of the duodenal papilla), which can irreversibly impair the function of the sphincter of Oddi, th.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Absorbable suture	COVIDIEN	4-0 VLOCL0603	-
Analog inflation device	MERIT MEDICAL	IN4130	-
Ciprofol	Haisco	H20213723	-
Disposable absorbable ligating clip	KANGJI	KJ-XJZ02L	-
Disposable cylindrical dilation catheter	JIUHONG	JHY-BD-08-40-110-A	8 mm × 4 cm
Disposable electrosurgical dissecting forcep	KANGJI	KJ-FL0205WT	5 mm × 330 mm
Disposable electrosurgical grasping forcep	KANGJI	KJ-ZQ0205	5 mm × 330 mm
Disposable electrosurgical hook	KANGJI	KJ-DN0205G	5 mm × 330 mm
Disposable electrosurgical scissor	KANGJI	KJ-JD0205W	5 mm × 330 mm
Disposable guidewire	JIUHONG	JHY-GW-80-150-C1	-
Disposable stone extraction basket	COOK	NCT4-017115	-
Hepatoprotective drug	CHIATAI TIANQING	H20051942	Magnesium Isoglycyrrhizinate Injection
Iodophor	LIKANG	31005102	500 mL
Laparoscope	STORZ	26003BA	30°, 10 mm
Normal saline	OTSUKA	H12020026	500 mL
Polymer ligation clip	SINOLINKS	LC-2-3	-
Prophylactic or therapeutic antibiotic	FUAN	H20123389	Cefmetazole Sodium for Injection
Rocuronium bromide	LUNAN	H20244041	-
Silicone drainage tube	CHANGER	419280	-
Specimen bag	WELL LEAD	20172061844	B type, 550 mL
SPSS Statistics	IBM	Version 27.0	-
Sterile surgical drape	AOJIAN	ASQ-69	-
Sufentanil	Humanwell	H20237165	-
Trocar	ANKER	AKCM10×100-10.8	-
Ultra-slim choledochoscope	INNOVEX	CS50H-20EU	-
Veress needle	ANKER	AKCM10×100-10.8	-