Antegrade transcystic balloon dilatation in emergency laparoscopic cholecystectomy with MRCP validation.

Authors

Edgar Lipping, Sten Saar, Jaan Kirss, Hardi Aaspõllu, Artjom Bahhir, Olga Gapejeva, Toomas Kangur, Mariliis Rauk, Arvo Reinsoo, Anneliise Teder, Peep Talving

Published in

European journal of trauma and emergency surgery : official publication of the European Trauma Society. Volume 52. Issue 1. Sep 01, 2026. Epub Sep 01, 2026.

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) remains the predominant treatment of common bile duct stones but single-stage laparoscopic management via antegrade transcystic balloon dilatation (ATBD) offers a compelling alternative. All prior studies validate success solely by intraoperative fluoroscopic cholangiography, with no prospective trial employing postoperative magnetic resonance cholangiopancreatography (MRCP).
This single-centre prospective study enrolled 100 consecutive patients with confirmed CBD stones requiring emergency laparoscopic cholecystectomy (LC). ATBD was attempted in all patients. Primary outcome was MRCP-confirmed CBD stone clearance. Secondary outcomes included operative time and postoperative complications.
One hundred consecutive patients were enrolled (median age 69 years; 38% male; 56% ASA III-IV). ATBD was performed in 88 patients (88%). Postoperative MRCP was performed in 86 of 88 patients (98%), with residual stones identified in 24 (28%; 95% CI 19.5-38.2%), corresponding to an MRCP-confirmed CBD clearance rate of 72% (95% CI 61.8-80.5%). The median operative time was 90 min (IQR 75-111.5). Among the 88 patients who underwent ATBD, postoperative complications occurred in 12 (14%), most commonly pancreatitis (4.5%) and deep surgical site infection (4.5%); one patient died following severe post-procedural pancreatitis with multiorgan failure. The median hospital length of stay was 6 days (IQR 4-7.5).
Postoperative MRCP identified residual stones in 28% of patients who underwent MRCP, corresponding to an MRCP-confirmed clearance rate of 72%. These findings support the routine use of postoperative MRCP in post-procedural assessment for patients undergoing transcystic laparoscopic common bile duct exploration.
NCT07490730, https://clinicaltrials.gov (registration date 16.03.2026).

PMID:
42678398
Bibliographic data and abstract were imported from PubMed on 01 Sep 2026.

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