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Background <p>Laparoscopic Common bile duct exploration (LCBDE), via transcystic or choledochotomy routes, offers a single-stage alternative to pre- or post-operative Endoscopic retrograde cholangiopancreatography with Laparoscopic cholecystectomy (ERCP + LC) to manage common bile duct stones. This meta-analysis compares the safety, efficacy, and outcomes of transcystic and choledochotomy approaches of LCBDE separately against ERCP +LC.</p> Methods <p>PubMed, Embase, Cochrane Central, and Web of Science were searched to May 2024 for randomised controlled trials (RCTs). Eligible studies directly compared LCBDE with ERCP+LC. The primary outcome was ductal clearance. Secondary outcomes assessed procedure-specific complications (bile leak, stricture, pancreatitis, sepsis/cholangitis, blood loss and mortality), conversion to open surgery, cross-over, operative time, and hospital stay. Risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model. Eleven RCTs (<i>n</i> = 1472) met inclusion criteria.</p> Results <p>Cumulative absolute event rates across all patients showed choledochotomy achieved the highest ductal clearance (93.5%) compared with transcystic (89.4%) and ERCP +LC (88.5%). Transcystic LCBDE showed the lowest overall morbidity but a higher ductal non-clearance rate (10.6%) and conversion to open surgery (3.5%). Pooled meta-analysis revealed choledochotomy was associated with significantly higher bile leak versus ERCP + LC (9.8% vs. 0.8%; RR 7.00, 95% CI 2.98–16.43, <i>P</i> &lt; 0.00001) but lower blood loss requiring transfusion (0% vs. 2.5%; RR 0.29, 95% CI 0.08–0.98, <i>P</i> = 0.05). ERCP + LC carried higher risks of post-procedure pancreatitis (2.6% cumulative; pooled RR 0.40 favouring choledochotomy, <i>P</i> = 0.08).</p> Conclusions <p>The transcystic and choledochotomy approaches have distinct and complementary roles. Treatment selection should be guided by stone size, duct anatomy, and clinical context.</p>

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Transcystic and choledochotomy approaches of laparoscopic bile duct exploration show distinct outcomes against ERCP + laparoscopic cholecystectomy in a meta-analysis of randomised controlled trials

  • 期刊论文

  • 发表日期：

    2026年7月22日

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  • Zeeshan Ahmed,
  • Colette Thompson-Reil,
  • Preethy D’Souza,
  • Rovan D’Souza,
  • N Ravishankar,
  • Samir Sahay,
  • Brian R Davidson

摘要

Background

Laparoscopic Common bile duct exploration (LCBDE), via transcystic or choledochotomy routes, offers a single-stage alternative to pre- or post-operative Endoscopic retrograde cholangiopancreatography with Laparoscopic cholecystectomy (ERCP + LC) to manage common bile duct stones. This meta-analysis compares the safety, efficacy, and outcomes of transcystic and choledochotomy approaches of LCBDE separately against ERCP +LC.

Methods

PubMed, Embase, Cochrane Central, and Web of Science were searched to May 2024 for randomised controlled trials (RCTs). Eligible studies directly compared LCBDE with ERCP+LC. The primary outcome was ductal clearance. Secondary outcomes assessed procedure-specific complications (bile leak, stricture, pancreatitis, sepsis/cholangitis, blood loss and mortality), conversion to open surgery, cross-over, operative time, and hospital stay. Risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model. Eleven RCTs (n = 1472) met inclusion criteria.

Results

Cumulative absolute event rates across all patients showed choledochotomy achieved the highest ductal clearance (93.5%) compared with transcystic (89.4%) and ERCP +LC (88.5%). Transcystic LCBDE showed the lowest overall morbidity but a higher ductal non-clearance rate (10.6%) and conversion to open surgery (3.5%). Pooled meta-analysis revealed choledochotomy was associated with significantly higher bile leak versus ERCP + LC (9.8% vs. 0.8%; RR 7.00, 95% CI 2.98–16.43, P < 0.00001) but lower blood loss requiring transfusion (0% vs. 2.5%; RR 0.29, 95% CI 0.08–0.98, P = 0.05). ERCP + LC carried higher risks of post-procedure pancreatitis (2.6% cumulative; pooled RR 0.40 favouring choledochotomy, P = 0.08).

Conclusions

The transcystic and choledochotomy approaches have distinct and complementary roles. Treatment selection should be guided by stone size, duct anatomy, and clinical context.