Clinical analysis of laparoscopic transcystic common bile duct exploration combined confluence microdissection or balloon dilatation at the cystic duct in day surgery laparoscopic cholecystectomy

doi:10.16139/j.1007-9610.2025.04.08

Abstract

Abstract:

Objective To investigate the safety and efficacy of combined confluence microdissection or balloon dilatation followed by laparoscopic transcystic common bile duct exploration (LTCBDE) in day surgery laparoscopic cholecystectomy. Methods The clinical data of 203 patients with day surgery laparoscopic cholecystectomy combined with LTCBDE from June 2021 to June 2024 in Beijing Friendship Hospital, Capital Medical University were retrospectively analyzed. They were divided into an observation group (59 cases, including 42 cases of confluent microdissection and 17 cases of balloon dilatation) and a conventional group (144 cases) according to the surgical technique used. Baseline characteristics, intraoperative exploration results, operation time, postoperative recovery and complications were compared between the two groups. Results The history of preoperative cholangitis or pancreatitis (P<0.001) was more common in the observation group. And total bilirubin level was significantly higher in the observation group than in the conventional group (P=0.035). The observation group had a longer operative time (P=0.014) and higher hospitalization costs (P=0.001), but there was no difference in intraoperative bleeding and postoperative discharge time. There were no serious postoperative complications in either group. Conclusions Under the premise of strict patient screening, day surgery LTCBDE combined with confluence microdissection or balloon dilatation can effectively solve the problem of difficult choledochoscopic access, with high safety and thoroughness of exploration. Both techniques provide a feasible minimally observation solution for day surgery biliary exploration.

Key words: Day surgery, Choledochoscopy, Transcystic duct, Confluence microdissection, Balloon dilatation

CLC Number:

R657.42

WU Hongwei, TONG Kuinan, LI Haonan, WANG Dong, LIU Kun, GUO Wei. Clinical analysis of laparoscopic transcystic common bile duct exploration combined confluence microdissection or balloon dilatation at the cystic duct in day surgery laparoscopic cholecystectomy[J]. Journal of Surgery Concepts & Practice, 2025, 30(04): 339-344.

Figures/Tables 2

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Tab 1

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Characteristics		Observation group（n=59）	Conventional group（n=144）	F/χ²/Z value	P value
Gender
	Male	24(40.7)	62(43.1)	χ²=0.097	0.756
	Female	35(59.3)	82(56.9)	χ²=0.097	0.756
Age（year）		45.75±13.00	49.30±8.03	F=42.556	0.055
BMI（kg/m²）		24.81±2.63	24.67±3.80	F=4.341	0.770
History of pancreatitis or cholangitis		21（35.6）	8（5.6）	χ²=96.718	<0.001
Preoperative ALT（U/L）		28（18，55）	29（20，38）	Z=-0.444	0.657
Preoperative ALP（U/L）		91（74，129）	87（69，119）	Z=-0.876	0.381
Preoperative GGT（U/L）		71（28，187）	89（61，117）	Z=-0.475	0.635
Preoperative TB（μmol/L）		14.60（10.65，18.49）	12.66（9.63，16.69）	Z=-2.113	0.035
Results of exploration
	Bile sludge	16(27.1)	20(13.9)	χ²=5.050	0.080
	Stone	25(42.4)	74(51.4)	χ²=5.050	0.080
Operative duration（min）		90（75，105）	80（75，95）	Z=-2.453	0.014
Intraoperative bleeding（mL）		15（10，20）	15（10，20）	Z=-0.485	0.628
Expenses（Yuan）		17 264.00（16 114.00，18 135.00）	16 557.00（15 448.75，17 455.00）	Z=-3.426	0.001
Length of hospital stay（h）		4（4，4）	4（4，4）	Z=-0.621	0.535