Clinical value of laparoscopy combined with choledochoscopy in the treatment of intrahepatic and extrahepatic bile duct stones: a retrospective analysis.

OBJECTIVE: To compare the clinical efficacy, postoperative recovery, and safety of laparoscopy combined with choledochoscopy versus traditional laparotomy for intrahepatic and extrahepatic bile duct stones. METHODS: Clinical data of 80 patients treated at Wenzhou People's Hospital from January 2022 to December 2024 were retrospectively analyzed. Patients were divided into an observation group (laparoscopy combined with choledochoscopy, n = 42) and a control group (traditional open bile duct exploration, n = 38). Operative parameters, stone clearance, postoperative recovery, complications, and follow-up outcomes were compared. RESULTS: Operation time was longer in the observation group than in the control group (128.5 ± 32.6 min vs. 98.3 ± 25.4 min, P < 0.001), but intraoperative blood loss was significantly lower (35.4 ± 18.7 mL vs. 42.6 ± 17.3 mL, P < 0.05). No significant differences were found in stone clearance or residual stone rate between groups (both P > 0.05). The observation group showed significantly better outcomes in gastrointestinal function recovery, postoperative ambulation, analgesic use, and hospital stay (all P < 0.01). Total complication rate was lower in the observation group (7.1% vs. 21.1%, P < 0.001). No significant differences were observed in 6-month stone recurrence rate or 3-month liver function between groups (both P > 0.05). CONCLUSION: Laparoscopy combined with choledochoscopy has a slightly longer operation time but offers less intraoperative blood loss, reduced trauma, faster postoperative recovery, and comparable long-term efficacy compared with traditional laparotomy for intrahepatic and extrahepatic bile duct stones.