Laparoscopic Transcystic Common Bile Duct Exploration: Advantages over Laparoscopic Choledochotomy.
OBJECTIVE
The ideal treatment for choledocholithiasis should be simple, readily available, reliable, minimally invasive and cost-effective for patients. We performed this study to compare the benefits and drawbacks of different laparoscopic approaches (transcystic and choledochotomy) for removal of common bile duct stones.


METHODS
A systematic search was implemented for relevant literature using Cochrane, PubMed, Ovid Medline, EMBASE and Wanfang databases. Both the fixed-effects and random-effects models were used to calculate the odds ratio (OR) or the mean difference (MD) with 95% confidence interval (CI) for this study.


RESULTS
The meta-analysis included 18 trials involving 2,782 patients. There were no statistically significant differences between laparoscopic choledochotomy for common bile duct exploration (LCCBDE) (n = 1,222) and laparoscopic transcystic common bile duct exploration (LTCBDE) (n = 1,560) regarding stone clearance (OR 0.73, 95% CI 0.50-1.07; P = 0.11), conversion to other procedures (OR 0.62, 95% CI 0.21-1.79; P = 0.38), total morbidity (OR 1.65, 95% CI 0.92-2.96; P = 0.09), operative time (MD 12.34, 95% CI -0.10-24.78; P = 0.05), and blood loss (MD 1.95, 95% CI -9.56-13.46; P = 0.74). However, the LTCBDE group showed significantly better results for biliary morbidity (OR 4.25, 95% CI 2.30-7.85; P<0.001), hospital stay (MD 2.52, 95% CI 1.29-3.75; P<0.001), and hospital expenses (MD 0.30, 95% CI 0.23-0.37; P<0.001) than the LCCBDE group.


CONCLUSIONS
LTCBDE is safer than LCCBDE, and is the ideal treatment for common bile duct stones.
Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China.
Qian
Q
Feng
Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China.
Yong
Y
Huang
Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China.
Kai
K
Wang
Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China.
Rongfa
R
Yuan
Department of Radiology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China.
Xiaoli
X
Xiong
Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China.
Linquan
L
Wu
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