ArticleSurgical endoscopy2026
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.
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundLaparoscopic 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.
methodsThis 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.
resultsBaseline 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 χ
conclusionsIn 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.
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