Many options exist for the management of cholelithiasis and secondary choledocholithiasis. Among them, laparoscopic common bile duct exploration (LCBDE) with choledocotomy followed by laparoscopic cholecystectomy has gained popularity. However, efforts should be made to ensure minimally invasive or noninvasive management of the common bile duct (CBD). The purpose of this study was to explore the clinical experience of non-invasive surgical modality, i.e., laparoscopic transcystic dilation of the cystic duct confluence in CBD exploration (LTD-CBDE), including feasibility, safety, adverse events, and incidence. In this retrospective analysis, 68 patients were offered the LTD-CBDE technique from December 2015 to April 2018 based on patient’s own intention. During the surgery, the cystic duct confluence was dilated with separation forceps and/or a columnar dilation balloon. Subsequently, CBD exploration and stone extraction were performed with a choledochoscope. The entrance of the CBD was covered with a cystic duct stump wall and was subjected to primary closure at the end of surgery. Forty-nine females and 19 males with cholelithiasis and secondary choledocholithiasis were included. The mean age was 53 years old (18 to 72 year). Of these patients, 62 (91.2%) were successfully treated with the LTD-CBDE technique, and bile leakage was observed in 3 patients (4.4%). The mean operation time was 106 min, and the mean hospital stay was 5.9 days. Among the other 6 patients, 3 were converted to open cholecystectomy due to severe fibrosis, unclear anatomical structure at Calot’s triangle (n = 2) or Mirizze syndrome (n = 1); LCBDE was performed in 3 patients due to cystic duct atresia (n = 2) and low level of flow from the gallbladder duct into the CBD (n = 1). These patients had a smooth postoperative course. In total, 43/68 of the patients presented no radiological evidence of retained CBD stones at the postoperative follow-up (40 patients treated with LTD-CBDE) 1 year later. The current work suggests that LTD-CBDE for the management of cholelithiasis and secondary choledocholithiasis is a feasible, safe and effective technique with a low complication rate. LTD-CBDE offers another alternative for surgeons to treat patients in similar scenarios. However, additional randomized, controlled studies are needed to demonstrate its efficacy, safety, and impact on CBD stenosis.

中文翻译：

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继发性胆总管结石患者的腹腔镜胆总管探查和结石摘除术中的胆囊管汇合扩张。

存在许多治疗胆石症和继发性胆石症的选择。其中，腹腔镜胆总管切开术随后腹腔镜胆囊切除术已广受欢迎。但是，应努力确保对胆总管（CBD）进行微创或无创管理。这项研究的目的是探讨无创手术方式的临床经验，即在CBD探查（LTD-CBDE）中进行腹腔镜胆囊管汇合术的囊性扩张术，包括可行性，安全性，不良事件和发生率。在这项回顾性分析中，根据患者自己的意愿，从2015年12月到2018年4月为68例患者提供了LTD-CBDE技术。手术期间 用分离钳和/或柱状扩张球囊扩张胆囊管汇合处。随后，用胆道镜进行CBD勘探和岩石提取。CBD的入口覆盖着一个胆囊管残端壁，在手术结束时进行了一次闭合。包括49例女性和19例患有胆石症和继发性胆总管结石的男性。平均年龄为53岁（18至72岁）。这些患者中，有62例（91.2％）用LTD-CBDE技术成功治疗，3例患者（4.4％）观察到胆汁渗漏。平均手术时间为106分钟，平均住院时间为5.9天。在其他6例患者中，有3例由于严重的纤维化，Calot三角形的解剖结构不清楚（n = 2）或Mirizze综合征（n = 1）而转为开腹胆囊切除术。由于胆囊管闭锁（n = 2）和从胆囊管到CBD的血流水平低（n = 1），在3例患者中进行了LCBDE。这些患者术后过程平稳。一年后，总共有43/68例患者在术后随访中未表现出保留CBD结石的放射学证据（40例接受LTD-CBDE治疗的患者）。目前的工作表明，LTD-CBDE治疗胆石症和继发性胆总管结石是一种可行，安全，有效的技术，并发症发生率低。LTD-CBDE为外科医生提供了另一种在类似情况下治疗患者的选择。但是，还需要其他随机对照研究来证明其疗效，安全性以及对CBD狭窄的影响。