ArticleUpdates in surgery2026
Transcystic and choledochotomy approaches of laparoscopic bile duct exploration show distinct outcomes against ERCP + laparoscopic cholecystectomy in a meta-analysis of randomised controlled trials.
Article in Updates in surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundLaparoscopic Common bile duct exploration (LCBDE), via transcystic or choledochotomy routes, offers a single-stage alternative to pre- or post-operative Endoscopic retrograde cholangiopancreatography with Laparoscopic cholecystectomy (ERCP + LC) to manage common bile duct stones. This meta-analysis compares the safety, efficacy, and outcomes of transcystic and choledochotomy approaches of LCBDE separately against ERCP +LC.
methodsPubMed, Embase, Cochrane Central, and Web of Science were searched to May 2024 for randomised controlled trials (RCTs). Eligible studies directly compared LCBDE with ERCP+LC. The primary outcome was ductal clearance. Secondary outcomes assessed procedure-specific complications (bile leak, stricture, pancreatitis, sepsis/cholangitis, blood loss and mortality), conversion to open surgery, cross-over, operative time, and hospital stay. Risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model. Eleven RCTs (n = 1472) met inclusion criteria.
resultsCumulative absolute event rates across all patients showed choledochotomy achieved the highest ductal clearance (93.5%) compared with transcystic (89.4%) and ERCP +LC (88.5%). Transcystic LCBDE showed the lowest overall morbidity but a higher ductal non-clearance rate (10.6%) and conversion to open surgery (3.5%). Pooled meta-analysis revealed choledochotomy was associated with significantly higher bile leak versus ERCP + LC (9.8% vs. 0.8%; RR 7.00, 95% CI 2.98-16.43, P < 0.00001) but lower blood loss requiring transfusion (0% vs. 2.5%; RR 0.29, 95% CI 0.08-0.98, P = 0.05). ERCP + LC carried higher risks of post-procedure pancreatitis (2.6% cumulative; pooled RR 0.40 favouring choledochotomy, P = 0.08).
conclusionsThe transcystic and choledochotomy approaches have distinct and complementary roles. Treatment selection should be guided by stone size, duct anatomy, and clinical context.
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