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Background <p>Single-stage management of choledocholithiasis during laparoscopic cholecystectomy can be performed using transcystic papillary balloon dilatation (TCPBD) or laparoscopic choledochoscopy (LCC). Direct comparative data between intraoperative clearance techniques remain limited.</p> Methods <p>We conducted a retrospective single-center observational cohort study of 132 consecutive adult patients undergoing documented one-stage minimally invasive treatment for choledocholithiasis between January 2020 and January 2026. Ninety-three patients underwent TCPBD and 39 underwent LCC. The primary endpoint was procedural success, defined as complete duct clearance during the index procedure without conversion, biliary drainage, retained stones requiring postoperative ERCP, or other additional duct-clearance procedures. Secondary endpoints included overall and major complications, postoperative pancreatitis, reoperation, conversion, operative time, and hospital length of stay. Propensity score matching was performed using age, body mass index, stone diameter, and acute calculous cholecystitis.</p> Results <p>Procedural success was achieved in 89/93 TCPBD patients (95.7%) and 36/39 LCC patients (92.3%) (OR 1.85, 95% CI 0.40–8.70; RD 3.4, 95% CI − 4.6 to 16.3; <i>p</i> = 0.421). Overall complications occurred in 9.7% versus 7.7% (OR 1.29, 95% CI 0.33–5.03; RD 2.0, 95% CI − 11.4 to 11.2; <i>p</i> = 1.000). Mild postoperative pancreatitis occurred in 4.3% versus 5.1% of patients. TCPBD patients were older, had higher body mass index, larger stones, and more frequent acute calculous cholecystitis. Postoperative length of stay was longer after TCPBD in the unmatched and adjusted analyses (IRR 1.47, 95% CI 1.08–2.00; <i>p</i> = 0.014), but this difference was attenuated after propensity score matching. Wide confidence intervals limit inference for uncommon outcomes.</p> Conclusions <p>In this retrospective non-randomized cohort, no statistically significant differences in duct-clearance success or morbidity were detected between TCPBD and LCC. Technique selection should remain individualized according to patient factors, biliary anatomy, stone characteristics, and available expertise. Prospective comparative studies are warranted.</p> Graphical abstract <p></p>

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Transcystic papillary balloon dilatation vs. laparoscopic choledochoscopy for choledocholithiasis: a retrospective observational propensity score-matched cohort study

  • 期刊论文

  • 发表日期：

    2026年7月31日

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  • Dmitrijs Aleksandrovs,
  • Haralds Plaudis,
  • Vladimirs Fokins,
  • Gļebs Griņovs,
  • Dmitrijs Skicko,
  • Kristians Šušpanovs,
  • Igors Ivanovs

摘要

Background

Single-stage management of choledocholithiasis during laparoscopic cholecystectomy can be performed using transcystic papillary balloon dilatation (TCPBD) or laparoscopic choledochoscopy (LCC). Direct comparative data between intraoperative clearance techniques remain limited.

Methods

We conducted a retrospective single-center observational cohort study of 132 consecutive adult patients undergoing documented one-stage minimally invasive treatment for choledocholithiasis between January 2020 and January 2026. Ninety-three patients underwent TCPBD and 39 underwent LCC. The primary endpoint was procedural success, defined as complete duct clearance during the index procedure without conversion, biliary drainage, retained stones requiring postoperative ERCP, or other additional duct-clearance procedures. Secondary endpoints included overall and major complications, postoperative pancreatitis, reoperation, conversion, operative time, and hospital length of stay. Propensity score matching was performed using age, body mass index, stone diameter, and acute calculous cholecystitis.

Results

Procedural success was achieved in 89/93 TCPBD patients (95.7%) and 36/39 LCC patients (92.3%) (OR 1.85, 95% CI 0.40–8.70; RD 3.4, 95% CI − 4.6 to 16.3; p = 0.421). Overall complications occurred in 9.7% versus 7.7% (OR 1.29, 95% CI 0.33–5.03; RD 2.0, 95% CI − 11.4 to 11.2; p = 1.000). Mild postoperative pancreatitis occurred in 4.3% versus 5.1% of patients. TCPBD patients were older, had higher body mass index, larger stones, and more frequent acute calculous cholecystitis. Postoperative length of stay was longer after TCPBD in the unmatched and adjusted analyses (IRR 1.47, 95% CI 1.08–2.00; p = 0.014), but this difference was attenuated after propensity score matching. Wide confidence intervals limit inference for uncommon outcomes.

Conclusions

In this retrospective non-randomized cohort, no statistically significant differences in duct-clearance success or morbidity were detected between TCPBD and LCC. Technique selection should remain individualized according to patient factors, biliary anatomy, stone characteristics, and available expertise. Prospective comparative studies are warranted.

Graphical abstract