Transcystic management of choledocholithiasis: Outcomes, factors associated with bile duct injury and implications for surgical practice.

Backgrounds/Aims: Choledocholithiasis with gallbladder in situ presents a complex surgical challenge. The transcystic approach offers a minimally invasive alternative to choledochotomy; however, its adoption remains limited. This study assessed the safety, efficacy, and reproducibility of this method. Methods: This retrospective study involved 71 patients diagnosed with choledocholithiasis and gallbladder in situ, all of whom underwent transcystic bile duct exploration at a primary care hospital. Demographic, clinical, and intraoperative variables were analyzed to determine predictors of bile duct injury. Results: Transcystic exploration achieved successful completion in 92.9% of cases and a duct clearance rate of 94%. The most common complication was bile duct injury, showing a significant association with previous endoscopic or percutaneous procedures ( Conclusions: The transcystic approach is a safe, effective, and reproducible first-line intervention for choledocholithiasis with gallbladder in situ. Patient-specific and disease-related factors primarily determine bile duct injury risk, rather than the surgical technique itself. Further prospective randomized studies are needed to confirm these findings.