Comparative outcomes of laparoscopic transcystic duct vs traditional laparoscopic bile duct exploration: A multicentre randomised trial

Abstract Aim This multicentre randomised controlled trial aimed to compare post‐operative complications and recovery outcomes between these two approaches. Patients and methods Eighty patients with symptomatic choledocholithiasis were randomly assigned to undergo either laparoscopic transcystic (LTCBDE; n = 40) or traditional (LCBDE; n = 40) common bile duct exploration. The primary outcome measures were post‐operative complications within 3 months, while the secondary outcomes included operative time, intraoperative blood loss, recurrence of bile duct stones, and time to return to activities of daily living (ADLs). Logistic regression models were used to identify predictors of complications and recurrence. Results The LTCBDE group had significantly shorter operative times (117.55 vs 136.05 min, P < .001) and reduced intraoperative blood loss (51.25 vs 61.45 mL, P < .001). Both groups had a 20% rate of post‐operative complications ( P = .614). Septic complications were higher in LCBDE compared with LTCBDE (20% vs 7.5%, P = .105). Time to return to ADL was shorter in the LTCBDE group (33.4 vs 39.75 days, P = .007). Diabetes mellitus independently predicted post‐operative complications (adjusted odds ratio 4.397, P = .014) and revision surgery (adjusted odds ratio 22.592, P = .006). Recurrence rates were similar between groups ( P = .363). Conclusion LTCBDE is associated with shorter operative times, reduced blood loss, and faster recovery than LCBDE, without an increase in post‐operative complications. LTCBDE may be the preferred option for the treatment of choledocholithiasis.