title: Transcystic approach with micro-incision of the cystic duct and its confluence part in laparoscopic common bile duct exploration.
abstract: BACKGROUND
  Laparoscopic transcystic common bile duct exploration has become a safe and ideal treatment of common bile duct stones. This study was designed to explore the clinical value of modified laparoscopic transcystic common bile duct exploration as a first line of treatment for patients with common bile duct stones.
  
  
  METHODS
  A retrospective, case-control study of clinically comparable groups of patients who underwent the laparoscopic transcystic approach with micro-incision of the cystic duct and its confluence part in common bile duct exploration (LTM-CBD) (n=110) and laparoscopic common bile duct exploration (LCBD) (n=100) under the care of one surgeon was performed. All clinical data were analyzed retrospectively.
  
  
  RESULTS
  There was no significant difference in terms of operation time between the two groups (P>.05). Postoperative hospital stay and abdominal drainage time were shorter in the LTM-CBD group than in the LCBD group (P<.05). Postoperative bile leakage was seen in 1 case (1 of 110) in the LTM-CBD group and 10 cases (10 of 100) in the LCBD group (P<.05). Twenty patients underwent T-tube drainage in the LCBD group, and primary closure was performed in the other patients; however, all cases in the LTM-CBD group underwent primary closure. The median follow-up was 12 months; 2 patients in the LCBD group who suffered from bile leakage presented with obstructive jaundice due to bile duct stenosis 6 months postoperatively.
  
  
  CONCLUSIONS
  LTM-CBD, which can avoid postoperative T-tube drainage, decrease complications, shorten hospitalization time, and enhance the existing quality, is a minimally invasive, safe, and effective treatment.
authors.affiliation: 1 Department of Hepatobiliary Surgery, The Third Affiliated Hospital of Soochow University , Changzhou, China .
authors.forename: Xue-Min
authors.initials: XM
authors.lastname: Chen
authors.forename: Yue
authors.initials: Y
authors.lastname: Zhang
authors.forename: Hui-Hua
authors.initials: HH
authors.lastname: Cai
authors.forename: Dong-Lin
authors.initials: DL
authors.lastname: Sun
authors.forename: Sheng-Yong
authors.initials: SY
authors.lastname: Liu
authors.forename: Yun-Fei
authors.initials: YF
authors.lastname: Duan
authors.forename: Chun
authors.initials: C
authors.lastname: Yang
authors.forename: Yong
authors.initials: Y
authors.lastname: Jiang
authors.forename: Hao-Rong
authors.initials: HR
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D001649:Bile Duct Diseases / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D016022:Case-Control Studies; D003135:Common Bile Duct / Q000601:surgery*; D003549:Cystic Duct / Q000601:surgery*; D004322:Drainage / Q000009:adverse effects / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D016896:Treatment Outcome