To explore the feasibility and safety of performing common bile duct exploration and stone removal through the cystic duct surgical approach under laparoscopy.

The clinical data of 54 patients with common bile duct stones and gallbladder stones from November 2020 to October 2024 were retrospectively analyzed. Among them, 30 were male and 24 were female, with an average age of (66.9±9.7) years. The patients were divided into two groups based on different surgical methods: 24 cases underwent indocyanine green (ICG) fluorescence laparoscopic cystic duct common bile duct exploration and stone removal (LTCBDE), and 30 cases underwent ICG fluorescence laparoscopic common bile duct incision and stone removal (LCBDE). The comparison included the time for identifying the cystic duct, common bile duct, and common duct, the time for common bile duct exploration and stone removal, the operation time, intraoperative blood loss; the success rate of the operation, stone clearance rate, postoperative hospital stay, hospitalization cost, and complications. Data were analyzed using SPSS 26.0 statistical software. Quantitative data with normal distribution were expressed as (±s), and comparisons between the two groups were performed using independent sample t tests. Count data were expressed as [cases (%)], and comparisons were conducted using the χ² test or Fisher’s exact probability method. P<0.05 was considered statistically significant.

Both groups successfully underwent the surgery. There were no statistically significant differences in the time for identifying the cystic duct, intraoperative blood loss, and operation success rate between the two groups (all P>0.05); however, the observation group had shorter time for common bile duct exploration and stone removal, and shorter operation time compared with the control group (all P<0.05). There was no statistically significant difference in the incidence of surgical complications and total hospitalization cost between the two groups (P>0.05), but there were statistically significant differences in the postoperative hospital stay and the duration of negative pressure drainage tube placement (all P<0.05).

For patients with gallbladder stones and common bile duct stones or those with indications for common bile duct exploration, performing common bile duct exploration and stone removal through the cystic duct is a safe and feasible surgical method, which avoids common bile duct incision and can avoid the impact of T-tube placement on the patient’s quality of life after surgery, reduces the postoperative hospital stay and the duration of negative pressure drainage tube placement, and is worthy of clinical promotion and implementation.