IDDF2021-ABS-0038 Safety and technical success of laparoscopic transcystic common bile duct exploration in patients with suspected choledocholithiasis but negative mrcp undergoing laparoscopic cholecystectomy

Background There is little research to evaluate laparoscopic transcystic common bile duct (CBD) exploration (LTCBDE) as a diagnostic test to identify choledocholithiasis undergoing laparoscopic cholecystectomy (LC). The aims of this study were to assess the technical success and safety of LTCBDE in patients with suspected choledocholithiasis but negative magnetic resonance cholangiopancreatography (MRCP) undergoing LC. Methods We did an ambispective cohort study in patients with gallstones and suspected CBD stones but negative MRCP undergoing LC. The primary outcomes were the rate of complication in the hospital. Results Between January 2010 and December 2018, 620 patients (median age, 58 years; 58.4% female) were eligible for the study. The success rate of LTCBDE was 91.8% and CBD stones were observed in 53.3% with a stone clearance rate of 99.3%. The overall postoperative complication rate was 0.65% and no death was recorded in the total cohort. Notably, the morbidity in LTCBDE is 0.53%. Retained CBD stones were diagnosed in 2 patients and managed by ERCP successfully. In LTCBDE cohort, the median duration of operation was 78 (60–100) min and the median postoperative hospital stay was 1 (1–2) days. Overall, at a mean follow-up of 4.1 (2.3–6.1) years, recurrent CBD stones occurred in 1.1% and all-cause mortality in 0.6%. Conclusions Our study suggests that LTCBDE is associated with a low risk of complications and can be performed safely in patients undergoing LC. The increased diagnostic yield of LTCBDE found in this study contributes to the reduce of retained stones’ incidence. Thus, LTCBDE should be considered the favored choice in the diagnostic algorithm for choledocholithiasis if patients with suspected choledocholithiasis but negative MRCP undergoing LC.