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Backgrounds/Aims: Choledocholithiasis with gallbladder in situ presents a complex surgical challenge. The transcystic approach offers a minimally invasive alternative to choledochotomy; however, its adoption remains limited. This study assessed the safety, efficacy, and reproducibility of this method. Methods: This retrospective study involved 71 patients diagnosed with choledocholithiasis and gallbladder in situ, all of whom underwent transcystic bile duct exploration at a primary care hospital. Demographic, clinical, and intraoperative variables were analyzed to determine predictors of bile duct injury. Results: = 0.031). Conversion to choledochotomy elevated the risk of injury, and incomplete duct clearance correlated with higher complication rates. No specific intraoperative techniques or devices exhibited a significant impact on outcomes. Imaging at six months demonstrated no persistent strictures, supporting the likelihood of transient inflammatory changes. Conclusions: The transcystic approach is a safe, effective, and reproducible first-line intervention for choledocholithiasis with gallbladder in situ. Patient-specific and disease-related factors primarily determine bile duct injury risk, rather than the surgical technique itself. Further prospective randomized studies are needed to confirm these findings.
Barros et al. (Wed,) studied this question.