To evaluate the application value of laparoscopic micro-incision of cystic duct confluence in patients with small-diameter common bile duct stones complicated with cholecystolithiasis.

Clinical data of 46 patients with small-diameter common bile duct stones complicated with cholecystolithiasis admitted to Jiangyin People's Hospital Affiliated to Nantong University from January, 2018 to December, 2021 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 28 patients were male and 18 female, aged from 21 to 74 years, with a median age of 47 years. The inner diameter of the upper segment of duodenum of common bile duct was 0.6-0.8 cm. According to different surgical approaches, all patients were divided into the micro-incision group (n=21) and control group (n=25). In the micro-incision group, laparoscopic micro-incision of cystic duct confluence was performed, and laparoscopic common bile duct incision was carried out in the control group. Perioperative conditions of all patients were observed. The length of postoperative hospital stay and indwelling time of drainage tube were compared by rank-sum test. The incidence of postoperative complications was compared by Chi-square test with continuity correction.

In the micro-incision group, the median length of postoperative hospital stay and indwelling time of drainage tube were 6 (5, 7) d and 5 (5, 6) d, significantly shorter than 7(6, 8) d and 6(6, 7) d in the control group (Z=-3.055, -3.330; P<0.05). In the micro-incision group, the incidence of bile leakage was 5%(1/21) and 12%(3/25) in the control group, and the difference was not statistically significant (χ²=0.117, P>0.05). Postoperative bile leakage was treated by abdominal drainage in two groups. In the control group, 1 patient suffered from recurrent common bile duct stones at postoperative 7 months. Excessive cystic duct residual complicated with residual cystic duct stones was found in the re-operation, and the patient recovered well postoperatively.

For patients with small-diameter common bile duct stones complicated with cholecystolithiasis, laparoscopic mini-incision of the cystic duct confluence is an efficacious treatment, which can accelerate postoperative recovery. However, eligible patients should be strictly selected before surgery. Close attention should be paid in the incidence of postoperative bile leakage.