Feasibility of transumbilical and prior caesarean scar access in single-incision laparoscopic common bile duct exploration for extrahepatic bile duct stones

Open common bile duct exploration (CBDE) for extrahepatic stones results in prominent abdominal scarring and substantial tissue trauma. Laparoscopic exploration offers minimal invasiveness and faster recovery and has proven superior to staged procedures; however, single-incision laparoscopic exploration remains inadequately studied. We retrospectively analysed data from 18 patients who underwent single-incision laparoscopic common bile duct exploration (SIL-CBDE) for extrahepatic bile duct stones between March 2022 and June 2024 in the Department of General Surgery at the 901st Hospital of the Joint Logistics Support Force. Demographic characteristics, surgical details, and outcomes were documented. Among the 18 patients, 7 were male and 11 were female, with a mean age of 47.72 ± 14.82 years. Surgical approaches included transumbilical (n = 14) and transabdominal via previous caesarean scars (n = 4). SIL-CBDE was successfully completed in 17 patients (94.4%), while one patient (5.6%) required conversion to three-port laparoscopy. No residual stones were found postoperatively, with an operation time of 160 (131.25, 185.00) minutes and a hospital stay of 5.50 (4.75, 7.00) days. An abdominal drain was placed in 11 patients (61.1%), while 7 (38.9%) did not receive prophylactic drainage. One patient (5.6%) experienced bile leakage after surgery, which was cured after abdominal drainage. All patients were monitored until October 2024, during which time there was no recurrence of stones, bile duct stricture, readmission, or fatality. SIL-CBDE appears to be a safe and feasible procedure. Furthermore, utilizing a previous caesarean section scar for access represents a novel application and may provide a valuable alternative for a specific subset of patients.