Laparoscopic Transcystic Versus Transcholedochal Common Bile Duct Exploration For Choledocholithiasis:A Meta-analysis

Objective: To compare the efficacy,feasibility and safety of laparoscopic transcystic common bile duct exploration(LTCBDE)and laparoscopic common bile duct exploration(LCBDE)in treatment of common bile duct stones.Methods: Studies on PubMed,Web of science,Cochrane Library,CNKI and Wanfang Datebase were searched systematically form 2009 to 2019 and filtered strictly according to criteria pre-established.Meta-analysis was performed by Stata12.0 SE software.Results: A total of 21 studies were finally included,involving 3804 patients with 1939 cases in LTCBDE group and 1865 cases in LCBDE group.The results of Meta-analysis showed that the stone clearance rate in LTCBDE group was significantly higher than that in LCBDE group(OR=1.51,95% CI=1.02–2.25,P=0.038).And the perioperative variables that include intraoperative blood loss(MD=–54.16,95% CI=–101.07–7.26),operative time(MD=–27.27,95% CI=–35.20–19.33),postoperative tube retention time(MD=–1.97,95% CI=–2.32–1.63),length of hospital stay(MD=–3.04,95% CI=–3.58–2.51)and hospitalization cost(MD= –3554.99,95% CI=–4209.66–2900.32)in LTCBDE group were all superior to those in LCBDE group(all P<0.05);the incidence rates of postoperative bile leakage(OR=0.28,95% CI=0.19–0.40),cholangitis(OR=0.33,95% CI=0.14–0.80),biliary stricture(OR=0.32,95% CI=0.11–0.91)and the overall complications(OR=0.33,95% CI=0.25–0.43)in LTCBDE group were all significantly lower than those in LCBDE group(all P<0.05),and no significant differences were noted in the incidence rates of postoperative pancreatitis(OR=0.56,95% CI= 0.24–1.32)and biliary tract injury or bleeding(OR=0.64,95%CI=0.24–1.71)between the two groups(both P>0.05).Conclusions: The study demonstrated LTCBDE was feasible,safe,effective and even less incidence of postoperative complications.It deserved to be promoted clinically under the premise of mastering its indications strictly and learning systematically.