Comparison of modified versus conventional laparoscopic transcystic biliary drainage in the management of cholecystocholedocholithiasis: safety and efficacy.

BACKGROUND: Laparoscopic transcystic biliary drainage (LTCBD) combined with cholecystectomy have been explored as a treatment for cholecystocholedocholithiasis, but early dislodgment of the drainage tube remains a major challenge. We developed a modified laparoscopic transcystic biliary drainage approach and aims to evaluate its safety and efficacy by comparing it with the conventional approach. METHODS: From April 2020 to December 2023, a total of 81 patients with cholecystocholedocholithiasis underwent LTCBD. In the early phase of the study, the conventional LTCBD (c-LTCBD) approach was performed, while in the later phase, a modified LTCBD (m-LTCBD) approach was implemented. The safety and efficacy of these two techniques were compared. RESULTS: Among the 81 patients, c-LTCBD was performed in 14 patients, while the remaining 67 patients underwent m-LTCBD. There were no significant differences between the two groups in age, sex, presence of jaundice, cystic duct diameter, common bile duct diameter, number of stones, or the requirement for emergency treatment. Further analysis revealed that no significant differences were observed between the two techniques on surgical outcomes including surgical duration, complication rates, extended functions, C-tube removal time, or mean maximum drainage volume. Importantly, the hospital stay duration was shorter in the m-LTCBD compared to the c-LTCBD group (t = 3.206, P = 0.002). Additionally, 9 cases of C-tube related adverse events (C-tube dislodgement /displacement) were observed, with the incidence significantly lower in the m-LTCBD group (5/67 vs. 4/14, respectively; χ2 = 5.224, P = 0.022). CONCLUSION: m-LTCBD is a safe and effective technique for external drainage and therapeutic access, offering a viable alternative for managing cholecystocholedocholithiasis.