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Background <p>Laparoscopic cholecystectomy (LC) is standard for gallstones, but residual cystic duct and common bile duct (CBD) stones occur due to lack of systematic intraoperative cystic duct exploration. This study evaluated the mid-to-long-term efficacy and safety of a modified procedure—Xinjiang-Gu Laparoscopic Cystic Duct Exploration and Lithotomy—in reducing residual biliary stones.</p> Methods <p>This retrospective cohort study enrolled patients undergoing LC for gallstones (08/2021–09/2023). Exclusion criteria: biliary malignancy, intraoperative CBD exploration, prior bilioenteric anastomosis, incomplete data. Patients were divided into control (conventional LC, <i>n</i> = 562) and test (LC with cystic duct exploration/lithotomy, <i>n</i> = 150) groups. Test group procedures included transverse cystic duct incision, direct bile visualization, milking, patency test (saline gravity drop), intraoperative cholangiography, and transcystic ureteroscope insertion for CBD exploration/stone removal. Primary outcome: symptomatic residual biliary stones detected during clinical follow-up. Median follow-up: test 40&#xa0;months, control 37&#xa0;months. Kaplan–Meier and log-rank tests were used.</p> Results <p>Baseline characteristics were comparable except age and follow-up. Intraoperative cystic duct stone diagnosis: control 100% milking; test 35.9% milking, 41.0% patency test, 23.1% endoscopy (<i>P</i> = 0.005). Test group identified 9 (6.0%) preoperatively undetected CBD stones (all treated) vs. 0 in control (<i>P</i> &lt; 0.001). Freedom from symptomatic residual stones: test 100% (0/150; one-sided 97.5% CI 0–2.88%) vs. control 97.15% (16/562 developed symptomatic stones; 95% CI 1.76–4.57%) (<i>P</i> = 0.037). Symptomatic primary CBD stones occurred in 0 vs. 6 patients (1.07%) (<i>P</i> = 0.169). No differences in bile leakage, bile duct injury, or symptoms. Kaplan–Meier curve showed better symptomatic-residual-stone-free survival for test group (log-rank <i>χ</i><sup>2</sup> = 4.331, <i>P</i> = 0.037).</p> Conclusions <p>In this retrospective cohort study, the integration of cystic duct patency testing, direct exploration, and stepwise transcystic endoscopic stone management was associated with a significantly lower incidence of symptomatic residual biliary stones after LC compared with conventional LC, with a favorable safety profile on mid-to-long-term follow-up. These findings warrant confirmation in prospective randomized trials.</p>

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Mid-to-long-term follow-up study on the application of cystic duct patency test and cystic duct exploration in laparoscopic cholecystectomy for calculous cholecystitis: Xinjiang-Gu laparoscopic cystic duct exploration

  • 期刊论文

  • 发表日期：

    2026年7月7日

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  • Xierzhati Abilimiti,
  • Dilareyi Dawulietihan,
  • Muladilijiang Maitibake,
  • Yutao Liu,
  • Jinlong Zhou,
  • Cheng Liu,
  • Yiwei Han,
  • Zhihua Qin,
  • Hao Gu

摘要

Background

Laparoscopic cholecystectomy (LC) is standard for gallstones, but residual cystic duct and common bile duct (CBD) stones occur due to lack of systematic intraoperative cystic duct exploration. This study evaluated the mid-to-long-term efficacy and safety of a modified procedure—Xinjiang-Gu Laparoscopic Cystic Duct Exploration and Lithotomy—in reducing residual biliary stones.

Methods

This retrospective cohort study enrolled patients undergoing LC for gallstones (08/2021–09/2023). Exclusion criteria: biliary malignancy, intraoperative CBD exploration, prior bilioenteric anastomosis, incomplete data. Patients were divided into control (conventional LC, n = 562) and test (LC with cystic duct exploration/lithotomy, n = 150) groups. Test group procedures included transverse cystic duct incision, direct bile visualization, milking, patency test (saline gravity drop), intraoperative cholangiography, and transcystic ureteroscope insertion for CBD exploration/stone removal. Primary outcome: symptomatic residual biliary stones detected during clinical follow-up. Median follow-up: test 40 months, control 37 months. Kaplan–Meier and log-rank tests were used.

Results

Baseline characteristics were comparable except age and follow-up. Intraoperative cystic duct stone diagnosis: control 100% milking; test 35.9% milking, 41.0% patency test, 23.1% endoscopy (P = 0.005). Test group identified 9 (6.0%) preoperatively undetected CBD stones (all treated) vs. 0 in control (P < 0.001). Freedom from symptomatic residual stones: test 100% (0/150; one-sided 97.5% CI 0–2.88%) vs. control 97.15% (16/562 developed symptomatic stones; 95% CI 1.76–4.57%) (P = 0.037). Symptomatic primary CBD stones occurred in 0 vs. 6 patients (1.07%) (P = 0.169). No differences in bile leakage, bile duct injury, or symptoms. Kaplan–Meier curve showed better symptomatic-residual-stone-free survival for test group (log-rank χ2 = 4.331, P = 0.037).

Conclusions

In this retrospective cohort study, the integration of cystic duct patency testing, direct exploration, and stepwise transcystic endoscopic stone management was associated with a significantly lower incidence of symptomatic residual biliary stones after LC compared with conventional LC, with a favorable safety profile on mid-to-long-term follow-up. These findings warrant confirmation in prospective randomized trials.