Laparoscopic Cystic Duct Balloon Dilation Combined with Transcystic Stone Extraction for the Treatment of Choledocholithiasis.

Common bile duct stones (CBDS) are a common benign disorder of the digestive system. Severe cases can be complicated by acute cholangitis or biliary pancreatitis, posing a potentially life-threatening risk to patients. Currently, the primary minimally invasive therapeutic modalities include endoscopic retrograde cholangiopancreatography (ERCP), laparoscopic choledochotomy for common bile duct exploration (LCCBDE), and laparoscopic transcystic common bile duct exploration (LTCBDE). However, ERCP requires incision of the duodenal papilla, which may irreversibly impair the sphincter of Oddi and increase the risk of retrograde biliary infections. Conversely, LCCBDE traditionally requires choledochotomy and T-tube placement, which not only elevates the risks of bile leakage and biliary stricture but also compromises the patient's quality of life. Although LTCBDE preserves the physiological integrity of the biliary tract, the conventional procedure is often technically demanding due to anatomical variations, such as a narrow cystic duct. To overcome this technical bottleneck, this study introduced laparoscopic cystic duct balloon dilation combined with LTCBDE to mechanically expand the narrow cystic duct. The authors retrospectively reviewed the clinical data of patients who underwent these three surgical modalities at the institution between 2018 and 2024. The results demonstrated that balloon dilation combined with the LTCBDE group showed favorable outcomes, including a shorter hospital stay, lower total hospitalization costs, and a low incidence of postoperative complications. These findings indicate that this modified approach appears to be a safe, effective, and cost-effective alternative strategy for the management of low-to-moderate complexity choledocholithiasis.