Laparoscopic Transcystic Versus Transductal Common Bile Duct Exploration: A Systematic Review and Meta-analysis

Objective To evaluate comparative outcomes of laparoscopic transcystic (TC) and transductal (TD) common bile duct (CBD) exploration. Methods We systematically searched MEDLINE, EMBASE, CINAHL, CENTRAL, the World Health Organization International Clinical Trials Registry, ClinicalTrials.gov, ISRCTN Register, and bibliographic reference lists. CBD clearance rate, perioperative complications, and biliary complications were defined as the primary outcome parameters. Procedure time, length of hospital stay, conversion to open procedure were the secondary outcomes. Combined overall effect sizes were calculated using random-effects models. Results We identified 30 studies reporting a total of 4073 patients comparing outcomes of laparoscopic TC ( n = 2176) and TD ( N = 1897) CBD exploration. The TC approach was associated with significantly lower overall complications (RD: −0.07, P = 0.001), biliary complications (RD: −0.05, P = 0.0003), and blood loss (MD: −16.20, P = 0.02) compared to TD approach. Moreover, the TC approach significantly reduced the length of hospital stay (MD: −2.62, P