Laparoscopic techniques for treating recurrent common bile duct stones: Our approach to minimally invasive treatment of cholelithiasis

The treatment of recurrent common bile duct stones poses a significant challenge. This study aimed to investigate the feasibility, safety, and key techniques for laparoscopic treatment of recurrent common bile duct stones. This retrospective study included 170 patients with recurrent common bile duct stones treated at our medical center from January 2019 to June 2023. The patients were divided into two groups based on the surgical approach: the laparoscopic group (N=105) and the open surgery group (N=65). Preoperative baseline clinical data and perioperative information were collected and compared between the two groups to assess the feasibility of laparoscopic treatment for recurrent common bile duct stones. All patients completed the surgical treatment, with similar average surgical durations between the two groups (178.21±53.11 min VS 172.05±50.06 min, P =0.45). The laparoscopic group experienced significantly less blood loss compared to the open group (20 [10-50] ml vs. 50 [30-100] ml, P<0.01), as well as a shorter average postoperative hospital stay (6.46±1.63 d VS 11.26±3.35 d, P ๤0.01). The incidence of complications was lower in the laparoscopic group (6 (5.7%) VS 15 (23.1%) , P =0.01), including a significantly lower rate of incision infections in the laparoscopic group (3 (2.9%) VS 13 (20.0%) , P ๤0.01). The rates of postoperative biliary fistula were similar between the two groups, and there were no reported cases of intra-abdominal infection in either group. There were no residual stones in both groups, and 6 patients (5.7%) in the laparoscopic group were converted to open surgery. At postoperative follow-up, the rate of stone recurrence was similar between the two groups (2 (3.1%) vs 3 (2.9%), P=1). Laparoscopic treatment for recurrent common bile duct stones is safe, effective, and feasible when performed by experienced surgeons proficient in both laparoscopic and open surgeries. Precise operation, appropriate instrument application, and flexible strategies are essential for successful surgery.