To explore the clinical efficacy and safety of modified laparoscopic transcystic common bile duct exploration (LTCBDE) in the treatment of choledocholithiasis.

A retrospective analysis was conducted on the clinical data of 103 choledocholithiasis patients who underwent modified LTCBDE in the Department of General Surgery in Beijing Electric Power Hospital between January 2022 and December 2024. Patients were divided into an elderly group (≥60 years, 77 cases) and a non-elderly group (<60 years, 26 cases) based on the age of 60. Additionally, the patients were categorized into a non-AOSC group (80 cases) and an AOSC group (23 cases) based on the presence or absence of acute obstructive suppurative cholangitis (AOSC).

All the surgeries were successful with a stone clearance rate of 100.0%. Preoperative American Society of Anesthesiologists (ASA) grading and the incidence of comorbidities were significantly higher in the elderly group compared to the non-elderly group, with more stones and longer postoperative hospital stays (P<0.05). Preoperative ASA grading and comorbidity rates were significantly higher in the AOSC group than those in the non-AOSC group, and more stones, with longer postoperative hospital stay (P<0.05). Minor bile leakage occurred in 3 patients in the elderly group, all of whom recovered after conservative management. During the 6-month postoperative follow-up, no patients exhibited complications such as residual common bile duct stones or stenosis, and no stone recurrence was observed.

Modified LTCBDE is a safe and effective treatment for choledocholithiasis in elderly patients, offering significant advantages including a high stone clearance success rate and fewer postoperative complications. For elderly patients with AOSC, this surgical procedure is not only safe and effective, but also promotes early recovery of patients, making it worthy of clinical application and promotion.​