Textbook outcome and associated risk factors in laparoscopic transcystic common bile duct exploration

doi:10.3748/wjg.v31.i31.109994

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Aug 21, 2025 (publication date) through Aug 18, 2025

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

World J Gastroenterol. Aug 21, 2025; 31(31): 109994
Published online Aug 21, 2025. doi: 10.3748/wjg.v31.i31.109994

Table 1 Univariate comparison of preoperative variables between textbook outcome and non-textbook outcome groups

Characteristic	All (n = 388)	TO achieved (n = 276)	TO not achieved (n = 112)	P value
Sex
Female	208	156	52	0.071
Male	180	120	60
Age	53.5 (18, 84)	52 (18, 83)	59 (28, 84)	< 0.01^a
BMI	23.66 ± 3.29	23.61 ± 3.54	23.78 ± 2.59	0.607
Admission laboratory tests
Platelet count (× 10⁹/L)	214 (179, 268)	222 (181, 279)	209 (176, 247)	0.166
White blood cell count (× 10⁹/L)	5.75 (4.75, 7.36)	5.76 (4.77, 7.35)	5.68 (4.53, 7.59)	0.694
Neutrophil count (× 10⁹/L)	3.30 (2.46, 4.73)	3.30 (2.46, 4.73)	3.41 (2.40, 5.43)	0.294
ALT (U/L)	71 (20, 228)	78 (18, 231)	65 (28, 227)	0.694
AST (U/L)	38 (22, 101)	37 (21, 98)	40 (25, 140)	0.162
TB (μmol/L)	20 (12.6, 40.5)	18.5 (12.6, 39.3)	25.6 (12.7, 58)	0.018^a
DB (μmol/L)	10.4 (4.5, 23.6)	9.5 (4.3, 20.5)	13.6 (6.2, 46.1)	0.005^a
ALP (U/L)	107.5 (74, 186)	105 (69, 177)	117.5 (81, 196)	0.098
γ-GT (U/L)	168.5 (41.2, 358.2)	179.5 (43.5, 368.7)	168.5 (41.2, 343)	0.751
Serum amylase (U/L)	32 (21, 65)	33 (26, 88)	29.5 (20, 71.2)	0.208
Urine amylase (U/L)	423 (239, 1077)	451.5 (254, 1111.8)	376.5 (183, 2028)	0.295
Fasting blood glucose (mmol/L)	5.14 (4.66, 6.01)	5.04 (4.67, 5.88)	5.59 (4.61, 6.62)	0.004^a
Preoperative imaging examinations
Common bile duct stone diameter	0.4 (0.3, 0.6)	0.3 (0.2, 0.5)	0.5 (0.3, 0.74)	0.004^a
Common bile duct diameter	0.9 (0.8, 1.1)	1.0 (0.8, 1.1)	0.95 (0.8, 1.3)	0.802
Cystic duct diameter	0.4 (0.34, 0.5)	0.4 (0.34, 0.5)	0.4 (0.34, 0.5)	0.921
Number of common bile duct stones				0.257
0	62	50	12
1	270	188	82
2	24	18	6
≥ 3	32	20	12
Gallbladder wall thickness				0.370
< 3 mm	194	142	52
≥ 3 mm	194	134	60
Intrahepatic bile duct dilation				0.303
No	238	174	64
Yes	150	102	48
Preoperative diagnoses				< 0.01^a
Cholecystolithiasis	24	12	12
Choledocholithiasis	322	240	82
Biliary pancreatitis	42	24	18
Preoperative interventions
Preoperative ERCP				0.007^a
No	376	272	104
Yes	12	4	8
Preoperative biliary drainage				0.165
No	356	254	102
PTCD	6	6	0
PTGD	26	16	10
Choledochoscope diameter used				0.408
3 mm	144	106	38
5 mm	244	170	74
Conversion to open surgery				0.026^a
No	386	276	110
Yes	2	0	2
Anesthesia time	106 (85, 137)	102 (82, 125)	125 (90, 170)	< 0.001^a
ASA score				0.032^a
1	32	24	8
2	316	230	86
3	38	22	16
4	2	0	2
Hypertension				0.095
No	286	210	76
Yes	102	66	36
Diabetes				0.88
No	352	250	112
Yes	36	26	10
Coronary heart disease				0.004^a
No	362	264	98
Yes	26	12	14

^aP value < 0.05.

TO: Textbook outcome; BMI: Body mass index; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; TB: Total bilirubin; DB: Direct bilirubin; ALP: Alkaline phosphatase; γ-GT: Γ-glutamyl transferase; ERCP: Endoscopic retrograde cholangiopancreatography; PTCD: Percutaneous transhepatic cholangial drainage; PTGD: Percutaneous transhepatic gallbladder drainage; ASA: American Society of Anesthesiologists.

Table 2 Analysis of perioperative factors associated with textbook outcome failure, n (%)

Outcome	All (n = 388)	Contribution to TO failure (n = 112)	Single contributor to TO failure (n = 112)
Conversion to open surgery	2 (0.52)	2 (1.78)	0
Postoperative complications (Clavien-Dindo classification ≥ 2)	12 (3.09)	12 (10.71)	0
Biliary leakage (ISGPS/ISGLS grade B/C)	4 (1.03)	4 (3.57)	0
Prolonged LOS (> 7 days)	50 (12.89)	50 (44.64)	14 (12.5)
Delayed removal of drainage tube (> 4 days)	94 (24.23)	94 (83.93)	54 (48.21)
Postoperative interventions
ERCP	2 (0.52)	2 (1.78)	0
Ultrasound-guided drainage	8 (2.06)	8 (7.14)	0
Reoperation	0	0	0
30-day readmission	4 (1.03)	4 (3.57)	4 (3.28)
Mortality	0	0	0

TO: Textbook outcome; ISGPS: International Study Group of Pancreatic Surgery; ISGLS: International Study Group of Liver Surgery; LOS: Length of stay; ERCP: Endoscopic retrograde cholangiopancreatography.

Table 3 Univariate and multivariate analysis of risk factors for achieving textbook outcome after laparoscopic transcystic common bile duct exploration

Factors	Univariate analysis		Multivariate analysis
Factors	OR (95%CI)	P value	OR (95%CI)	P value
Age	1.030 (1.015-1.045)	< 0.01^b	1.027 (1.006-1.048)	0.010^a
Sex
Female	Reference
Male	1.500 (0.965-2.332)	0.072^b
White blood cell count (× 10⁹/L)	0.995 (0.980-1.010)	0.524
Neutrophil count (× 10⁹/L)	0.999 (0.987-1.011)	0.828
Platelet count (× 10⁹/L)	0.999 (0.996-1.002)	0.363
ALT (U/L)	1.000 (0.999-1.001)	0.652
AST (U/L)	1.001 (1.000-1.002)	0.084^b
TB (μmol/L)	1.004 (0.999-1.009)	0.156
DB (μmol/L)	1.000 (0.997-1.002)	0.742
ALP (U/L)	1.002 (1.000-1.004)	0.026^b	1.002 (1.000-1.005)	0.048^a
γ-GT (U/L)	1.000 (0.999-1.001)	0.713
Serum amylase (U/L)	1.000 (0.999-1.001)	0.915
Urine amylase (U/L)	1.000 (1.000-1.000)	0.950
Fasting blood glucose (mmol/L)	1.247 (1.076-1.445)	0.003^b
Gallbladder wall thickness
< 3 mm	Reference
≥ 3 mm	1.223 (0.787-1.889)	0.370
Number of common bile duct stones
0	Reference
1	1.717 (0.867-3.401)	0.121
≥ 2	2.000 (0.856-4.673)	0.109
Common bile duct stone diameter	1.871 (1.092-3.206)	0.023^b
Common bile duct diameter	0.931 (0.615-1.409)	0.735
Intrahepatic bile duct dilation
No	Reference
Yes	1.265 (0.809-1.978)	0.303
Cystic duct diameter	1.039 (0.834-1.293)	0.734
Preoperative ERCP
No	Reference
Yes	5.231 (1.542-17.741)	0.008^b	5.408 (1.276-22.922)	0.022^a
Preoperative biliary drainage
No	Reference
PTGD/PTCD	1.132 (0.518-2.474)	0.756
Choledochoscope diameter
3 mm	Reference
5 mm	1.102 (0.875-1.387)	0.408
BMI	1.016 (0.950-1.086)	0.651
Anesthesia time	1.020 (1.014-1.026)	< 0.001^b	1.016 (1.010-1.023)	< 0.001^a
ASA score
< 3	Reference
≥ 3	2.211 (1.135-4.305)	0.02^b
Hypertension
No	Reference
Yes	1.507 (0.929-2.444)	0.096^b
Diabetes
No	Reference
Yes	0.943 (0.439-2.025)	0.880
Coronary heart disease
No	Reference
Yes	3.143 (1.405-7.031)	0.005^b

^aP value < 0.05.

^bP value < 0.1.

OR: Odds ratio; CI: Confidence interval; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; TB: Total bilirubin; DB: Direct bilirubin; ALP: Alkaline phosphatase; γ-GT: Γ-glutamyl transferase; ERCP: Endoscopic retrograde cholangiopancreatography; PTCD: Percutaneous transhepatic cholangial drainage; PTGD: Percutaneous transhepatic gallbladder drainage; BMI: Body mass index; ASA: American Society of Anesthesiologists.

Citation: Zhu DS, Zhang Z, Huang XR, Zhang JZ, Zhang ZW, Guo XY, Zheng H, Guo T, Yu YH. Textbook outcome and associated risk factors in laparoscopic transcystic common bile duct exploration. World J Gastroenterol 2025; 31(31): 109994
URL: https://www.wjgnet.com/1007-9327/full/v31/i31/109994.htm
DOI: https://dx.doi.org/10.3748/wjg.v31.i31.109994