Laparoscopic transcystic common bile duct exploration following prior gastrectomy: the safety and feasibility Running head: Laparoscopic transcystic common bile duct exploration

Background: Previous gastrectomy (PG) can lead to an increased incidence of gallstones. The purpose of this study was to evaluate the safety and feasibility of laparoscopic transcystic common bile duct exploration (LTCBDE) for PG patients. Methods A total of 300 patients who received LTCBDE in the same center from January 2015 to June 2023 were retrospectively evaluated. According to the PG status, the patients were divided into two groups: PG group and No-PG group. The characteristics of the disease, cystic duct incision method, surgical results and complications were analyzed. Results LTCBDE was performed in 300 patients. Among them, 59 patients had a history of gastrectomy. In general, the success rate of LTCBDE was 93%, 1 (0.3%) was converted to laparotomy, 21 (7%) underwent laparoscopic common bile duct exploration + T-tube drainage, and 3 (1%) did not find stones during intraoperative exploration. Complications occurred in 45 (15%). There was no significant difference in postoperative complications between PG group and No-PG group. In multivariate analysis, Calot 's triangle adhesion (hazard ratio (HR): 0.383, 95% confidence interval (CI): 0.185–0.792, P  = 0.010) and anatomical variation of bile duct (HR: 0.349, 95% CI: 0.162–0.749, P  = 0.007) were risk factors for overall complications. Conclusions LTCBDE is safe and feasible for PG patients. With the continuous advancement of technology, LTCBDE has been effectively promoted and applied.