Retrospective Cohort Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 21, 2025; 31(31): 109994
Published online Aug 21, 2025. doi: 10.3748/wjg.v31.i31.109994
Textbook outcome and associated risk factors in laparoscopic transcystic common bile duct exploration
Deng-Sheng Zhu, Zhen Zhang, Xiao-Rui Huang, Jing-Zhao Zhang, Zhi-Wei Zhang, Xin-Yi Guo, Huan Zheng, Tong Guo, Ya-Hong Yu
Deng-Sheng Zhu, Zhen Zhang, Xiao-Rui Huang, Jing-Zhao Zhang, Zhi-Wei Zhang, Xin-Yi Guo, Huan Zheng, Tong Guo, Ya-Hong Yu, Department of Biliopancreatic Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430000, Hubei Province, China
Co-first authors: Deng-Sheng Zhu and Zhen Zhang.
Co-corresponding authors: Tong Guo and Ya-Hong Yu.
Author contributions: Zhu DS and Zhang Z contributed equally to this work as co-first authors; Zhu DS was responsible for study design, data curation, conceptualization, methodology, and drafting the initial manuscript; Zhang Z performed formal data analysis and co-drafted the manuscript; Huang XR and Zhang JZ completed case data collection, follow-up, and data organization; Zhang ZW and Guo XY provided manuscript revision suggestions; Zheng H participated in the literature search for the manuscript and the production of related figures and tables; Guo T and Yu YH, as co-corresponding authors, contributed equally to study supervision, funding acquisition, and critical review/editing of the manuscript. All authors approved the final version of the manuscript.
Institutional review board statement: The study was approved by the Ethics Committee of Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, No. TJ-IRB202504074.
Informed consent statement: After review by the Ethics Committee of Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, a waiver of informed consent was granted for this subject.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author. Participants gave informed consent for data sharing.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ya-Hong Yu, MD, Chief Physician, FRCS (Gen Surg), Professor, Department of Biliopancreatic Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan 430000, Hubei Province, China. yuyahong615@sina.com
Received: May 28, 2025
Revised: June 20, 2025
Accepted: July 25, 2025
Published online: August 21, 2025
Processing time: 82 Days and 21.3 Hours
Abstract
BACKGROUND

Textbook outcome (TO), an emerging composite metric for surgical quality assessment, has recently gained recognition for evaluating perioperative results. Laparoscopic transcystic common bile duct exploration (LTCBDE) has become a widely adopted minimally invasive technique for treating cholecystolithiasis with choledocholithiasis. Despite its growing clinical application, TO has not yet been formally defined for LTCBDE, nor have its failure-associated risk factors been systematically examined.

AIM

To define TO for LTCBDE, establish standardized criteria, and identify risk factors for TO failure via logistic regression.

METHODS

A retrospective cohort of 388 patients who underwent LTCBDE in combination with laparoscopic cholecystectomy at the Department of Biliopancreatic Surgery, Tongji Hospital, from January 2018 to October 2024, was analyzed. The study delineated TO criteria for LTCBDE, calculated the rate of TO achievement, and employed logistic regression to determine independent predictors of TO failure.

RESULTS

TO was defined as the absence of the following seven criteria: Conversion to open surgery, postoperative complications (Clavien-Dindo grade ≥ 2), biliary leakage (International Study Group of Pancreatic Surgery/International Study Group of Liver Surgery grade B/C), delayed removal of drainage tube (> 4 days), postoperative interventions, prolonged length of stay (> 7 days), and 30-day readmission or mortality. Among 388 patients, 276 (71.1%) achieved TO. The primary causes of TO failure included delayed removal of drainage tube (94 cases, 83.9%), prolonged length of stay (50 cases, 44.6%). Multivariate analysis revealed four independent risk factors for TO failure: Preoperative endoscopic retrograde cholangiopancreatography (P = 0.022), advanced age (P = 0.010), prolonged anesthesia time (P < 0.001), and elevated preoperative alkaline phosphatase levels (P = 0.048).

CONCLUSION

These findings suggest that applying the concept of TO to LTCBDE enhances surgical quality evaluation and supports early identification of high-risk patients, facilitating personalized clinical decisions and optimizing individual management.

Keywords: Laparoscopic transcystic common bile duct exploration; Textbook outcome; Choledocholithiasis; Risk factors; Endoscopic retrograde cholangiopancreatography

Core Tip: This study defined textbook outcome (TO) criteria for laparoscopic transcystic common bile duct exploration as the absence of seven criteria: Conversion to open surgery, postoperative complications (Clavien-Dindo grade ≥ 2), biliary leakage (International Study Group of Pancreatic Surgery/International Study Group of Liver Surgery grade B/C), delayed removal of drainage tube (> 4 days), postoperative interventions, prolonged length of stay (> 7 days), and 30-day readmission or mortality. Factors independently associated with TO failure included preoperative endoscopic retrograde cholangiopancreatography, advanced age, prolonged anesthesia time, and elevated preoperative alkaline phosphatase levels. This investigation addresses the existing gap in TO evaluation within laparoscopic transcystic common bile duct exploration and contributes to risk stratification efforts, optimizing individual management.